[Senate Hearing 113-280]
[From the U.S. Government Publishing Office]
S. Hrg. 113-280
HEARING ON PENDING HEALTH AND BENEFITS LEGISLATION
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
OCTOBER 30, 2013
__________
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COMMITTEE ON VETERANS' AFFAIRS
Bernard Sanders, (I) Vermont, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Johnny Isakson, Georgia
Sherrod Brown, Ohio Mike Johanns, Nebraska
Jon Tester, Montana Jerry Moran, Kansas
Mark Begich, Alaska John Boozman, Arkansas
Richard Blumenthal, Connecticut Dean Heller, Nevada
Mazie Hirono, Hawaii
Steve Robertson, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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October 30, 2013
SENATORS
Page
Sanders, Hon. Bernard, Chairman, U.S. Senator from Vermont....... 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 3
Tester, Hon. Jon, U.S. Senator from Montana...................... 11
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 13
Hirono, Hon. Mazie, U.S. Senator from Hawaii..................... 13
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 14
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 15
Heller, Hon. Dean, U.S. Senator from Nevada...................... 17
Begich, Hon. Mark, U.S. Senator from Alaska...................... 47
WITNESSES
Reed, Hon. Jack, U.S. Senator from Rhode Island.................. 4
Nelson, Hon. Bill, U.S. Senator from Florida..................... 5
Prepared statement........................................... 6
Franken, Hon. Al, U.S. Senator from Minnesota.................... 7
Coats, Hon. Daniel, U.S. Senator from Indiana.................... 8
Prepared statement........................................... 9
Heinrich, Hon. Martin, U.S. Senator from New Mexico.............. 10
Jesse, Robert L., M.D., Ph.D., Principal Deputy Under Secretary
for Health, U.S. Department of Veterans Affairs................ 18
McLenachen, David R., Director, Pension and Fiduciary Service,
Veterans Benefits Administration, U.S. Department of Veterans
Affairs; accompanied by Richard Hipolit, Assistant General
Counsel and Jane Clare Joyner, Deputy Assistant General Counsel 20
Combined Prepared statement.................................. 21
Additional Views............................................. 31
Response to request arising during the hearing by Hon.
Richard Burr............................................... 56
Atizado, Adrian, Assistant National Legislative Director,
Disabled American Veterans..................................... 57
Prepared statement........................................... 58
Norton, Col. Robert F., USA (Ret.), Deputy Director, Government
Relations, Military Officers Association of America............ 75
Prepared statement........................................... 76
Weidman, Rick, Executive Director for Policy and Government
Affairs, Vietnam Veterans of America........................... 83
Prepared statement........................................... 84
APPENDIX
Rockefeller, Hon. John D., IV, U.S. Senator from West Virginia;
prepared statement............................................. 97
Aguon, Hon. Frank B., Jr., Chairman, Committee on Guam U.S.
Military Relocation, Homeland Security, Veterans' Affairs, and
the Judiciary; letter.......................................... 98
American Federation of Government Employees, AFL-CIO and the AFGE
National Veterans' Affairs Council; prepared statement......... 99
Wallis, Anthony A., Legislative Director, Association of the
United States Navy; letter..................................... 101
Spencer, Wendy, Chief Executive Officer, Corporation for National
and Community Service; letter.................................. 102
Kelly, Keith, Assistant Secretary of Labor For Veterans'
Employment and Training, U.S. Department of Labor; prepared
statement...................................................... 103
Greene, Bryan, Acting Assistant Secretary for the Office of Fair
Housing and Equal Opportunity, Department of Housing and Urban
Development; prepared statement................................ 104
Iraq & Afghanistan Veterans of America; prepared statement....... 105
Infectious Diseases Society of America; prepared statement....... 114
Horton, J. Don, President, WW II Coastwise Merchant Mariners;
letter......................................................... 116
Koehl, Paul J. and family; letter................................ 125
Slagle, Brad, President, National Association of State Veterans
Homes; prepared statement...................................... 127
Bergman, David, J.D., Vice President of Legal and External
Affairs, Chief Legal Officer, National Board for Certified
Counselors, Inc. and Affiliates; prepared statement............ 129
National Coalition for Homeless Veterans; prepared statement..... 131
Paralyzed Veterans of America; prepared statement................ 134
National Legislative Service, Veterans of Foreign Wars of the
United States; prepared statement.............................. 142
Wounded Warrior Project; prepared statement...................... 151
HEARING ON PENDING HEALTH AND BENEFITS LEGISLATION
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WEDNESDAY, OCTOBER 30, 2013
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 2:04 p.m., in
room 418, Russell Senate Office Building, Hon. Bernard Sanders,
Chairman of the Committee, presiding.
Present: Senators Sanders, Tester, Begich, Blumenthal,
Hirono, Burr, Isakson, Johanns, and Heller.
OPENING STATEMENT OF HON. BERNARD SANDERS,
CHAIRMAN, U.S. SENATOR FROM VERMONT
Chairman Sanders. Good morning everyone. I will make an
opening statement, Senator Burr will make an opening statement,
and then we will hear from the Senators who have been so kind
to join us today to talk about legislation that they are
proposing.
Today's agenda, once again, reflects important work by
Senators on both sides of the aisle and demonstrates the
Committee's desire to be responsive to the concerns expressed
by veterans and their families.
Before I discuss a few of the bills I have on today's
agenda, I want to briefly touch on the issue of the
Administration's views. Let me be kind of to the point on this
one.
I understand that, as a result of the government shutdown
and a lot of pressure on the VA, they have not gotten all of
their comments and views in. We also understand that in the
past they have not always been prompt in their responses to the
legislation that we have proposed.
So, let me just say this to them. The job of this Committee
and what we were elected to do is to represent the people of
this country and, in particular, the veterans of this country.
If the VA is not responsive in getting their comments in, that
is fine. It is not going to impact us at all. We are going to
go forward.
But clearly, the VA is going to have to implement the
policies developed by this Committee and this Congress and we
want to work with them. But our job is to legislate and we are
going to go forward with or without the cooperation of the VA
and the Administration.
Let me touch on some of the pieces of legislation that I
will be talking about today and will be introducing. At the top
of my list is the issue of expanding access to VA health care.
In my view--and I think VA does not get enough credit for
this--VA is running a very high-quality, cost-effective health
care system in this country. The media does not pick up on it
and I think many Americans just do not understand what the VA
does. But the fact is that veterans do understand that.
I can tell you that in Vermont, and I suspect in other
facilities that I have seen, I have been very impressed by the
kind of out-of-the-box work done by the VA, providing excellent
quality care in a cost-effective way.
Is the VA perfect? When you run 152 hospitals and 900
CBOCs, believe me they have problems every single day but so
does every other medical institution in America.
One of the goals that we are shooting for is to expand VA
health care, understanding that the major function of the VA
and their highest priority is to take care of those who are
service-connected. That goes without saying. There is no debate
about that. Men and women who have served this country and have
been wounded are getting their care at the VA. That is the
highest priority. We want to take care of indigent veterans as
well.
I think we can expand what we are doing and bring more
veterans into the system. While it may cost the VA more money,
it will save money in terms of what we spend on health care in
general because VA health care is cost-effective. That is issue
number 1.
Issue number 2, where I think we need to make some changes
is regarding dental care. Senator Burr and I both sit on the
Health, Education, Labor, and Pensions Committee. We talk a lot
about health care.
One of the issues that is not talked about a lot in this
country is the crisis in dental care. It is a huge crisis.
Millions of people have no insurance. Millions of adults are
seeing their teeth rotting in their mouths which, by the way,
leads to other types of health care problems.
We are introducing legislation which, for the first time,
would allow veterans to get dental care other than service-
connected. Right now if you are service-connected, you get good
quality dental care. If you are not, you do not.
I was recently in Tuscaloosa, AL, talking to the dental
people there, and the guy who is running their dental
department was telling me that it breaks his heart that they
have Purple Hearts walking in who cannot get dental care.
So, I think we have a crisis, and we are going to start
with some pilot projects which I think will begin to address a
very, very serious problem.
Another issue that we are going to address is sexual
assault and domestic abuse. We know sexual assault occurs all
too often in the military. Everybody here is aware of that.
That is not acceptable.
According to DOD, an estimated 26,000 servicemembers
experienced unwanted sexual contact in 2012; and we all
understand, by the way, that it is not just women. Men are
being sexually assaulted as well. This is an issue we are going
to address.
We are also going to strengthen the SCRA. When men and
women volunteer to serve in the Armed Forces, they should do so
knowing Congress will do all it can to support their efforts.
Congress enacted the Servicemembers Civil Relief Act for
just that reason, to enable servicemembers to devote their
focus to the defense needs of this country. As I think Members
of the Committee know, we took a close look at these
protections at a hearing earlier this year and we learned that
there was room for improvement, and that is why I introduced
the SCRA Enhancement and Improvement Act of 2013.
Also, we have introduced legislation that addresses
concerns of the Independent Budget of VSOs related to VA
compensation for hearing loss and related injuries, life
insurance for service-disabled veterans, and automobile grants
for some of our most disabled veterans.
So, let me conclude by saying that we are trying very hard
to run this Committee in a bipartisan way because I have no
doubt that my Republican colleagues absolutely feel as strongly
as my Democratic colleagues and I do on the issue of veterans,
and I hope we have done that, and I want to continue to do
that. And if I am not doing that, I want to hear from my
Republican friends.
I think we are making progress and we have a long way to
go. We look forward to that progress.
Now, Senator Burr, the mic is yours.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Good afternoon, Mr. Chairman. We have spent
most of the day together. It is appropriate that we would end
the day together. And I welcome our gang of colleagues that are
here to promote, I am sure, legislation that they are
passionate about.
To start with, I want to offer a few observations about
today's agenda. First of all, for many of the programs that
these bills would change, the Committee has not yet had
oversight hearings to examine what gaps in inefficiencies might
exist.
Also, there are dozens of bills on the agenda, even though
I do not think we can thoroughly cover but a handful of them at
a legislative hearing like this; and we are, again, considering
many bills that have significant cost but do not include
suggestions how to pay for them. I am not saying anything new
to the Chairman and hopefully I get an ``A'' for consistency.
So, it is my hope that, as we consider what bills should be
advanced, the Committee will take steps to ensure that we have
a clear understanding of how well existing programs are
working, one; and what changes are truly needed and how much
any changes would, in fact, cost. We should always find ways to
pay for any needed legislation so that we do not continue to
saddle future generations with a crushing debt.
Before I turn it back to you, Mr. Chairman, I want to
briefly mention two bills I have introduced that would provide
straightforward solutions for ongoing issues.
First is the Veterans Dialysis Pilot Program Review Act. In
2009, the VA created a dialysis pilot program at four VA
medical centers to provide dialysis treatment in local
communities using VA clinics versus private contractors. Now,
VA intends to roll out the program nationally while at the same
time contracting for independent analysis of how well it is
working.
In my view, the pilot program should be properly evaluated
before starting a national program. So, this bill would direct
the VA to halt any new dialysis clinics until the pilot sites
have been open for at least 2 years (which was the only general
language of the pilot program), an independent analysis of all
four pilot sites is conducted, and a report of those analyses
is submitted to Congress.
The only intent of this bill is to ensure that before VA
creates a national program, we first figure out if that would
be in the best interest of our veterans and of our taxpayers.
I have also introduced a bill in response to several recent
quality management issues at VA medical facilities that have
unfortunately resulted in patient harm and death. These issues
range from the misuse of insulin pens, to the outbreak of
Legionella, to delays in patient care.
This bill would address overarching themes that were
identified as contributing to the poor quality of care of all
of these incidents by taking steps requiring VA to have an up-
to-date policy about reporting certain infectious diseases and
to develop performance measures to assess how well these
policies are being followed.
Mr. Chairman, I want to thank you for this legislative
hearing, I look forward to hearing from our colleagues, and I
look forward to future action on these bills.
Chairman Sanders. Senator Burr, thank you very much.
We welcome our colleagues who are not on the Committee.
Thank you very much for your interest in Veterans Affairs and
thank you for being here today.
Let us start with Senator Reed.
STATEMENT HON. JACK REED,
U.S. SENATOR FROM RHODE ISLAND
Senator Reed. Well, thank you very much, Mr. Chairman,
Ranking Member Burr, and distinguished Members of the
Committee. Thank you again for the opportunity to speak today
regarding legislation that I have introduced to help
servicemembers and their families.
S. 1593 is the Servicemember Housing Protection Act. Our
country has had a strong tradition of ensuring that the laws
that protect our servicemembers keep pace with the challenges
they face. Having had the privilege of serving in the Army at,
among other places, Fort Bragg, NC, and Fort Benning, GA, I
personally know the importance and value of these laws, and I
commend you for what you are doing in this Committee.
My proposed legislation would continue this tradition of
protecting our servicemen and women, and it seeks to address a
continuing challenge, helping them with their housing needs so
that they can maintain their focus on the difficult task of
protecting our country.
S. 1593, the Service Member Housing Protection Act, takes
several critical steps to enhance provisions provided under the
Servicemembers Civil Relief Act, SCRA, to our Armed Forces.
First, the bill would make it easier for servicemembers to
claim deployment-related financial and credit protections by
expanding what could be submitted to constitute, ``military
orders.''
Currently, creditors require a copy of military orders in
order to trigger SCRA protections. However, these orders are
often not cut until just before deployment or once the
servicemember is already deployed which has placed a stressful
burden on some families as they try to work with banks to
secure SCRA protections.
Broadening the scope of what could be submitted to trigger
protections before orders have been received, to include a
letter or other form of certification from a servicemember's
commanding officer would further ensure that these members have
the protections of the SCRA.
Second, this bill would extend foreclosure protections to
surviving spouses. Currently, servicemembers have a one-year
window of foreclosure protection following service to provide
time to reacclimate to civilian life and get their personal
affairs back in order.
Our bill extends this 1-year window of foreclosure
protection to a surviving spouse who is the successor in
interest to the home. After suffering an unspeakable loss of a
servicemember, a military spouse should not have the additional
burden of dealing with the immediate foreclosure.
Last, the bill would help facilitate the transition from
off-base to on-base housing. Due to the shortage of on-base
military housing, many servicemembers find off-base housing
until on-base housing becomes available.
When servicemembers who are on a waiting list, which can be
at least 2 years, are finally given a chance to move into on
base housing, they sometimes are not able to terminate their
off-base housing lease. Including an order of opportunity to
move from off-base to on base housing as additional grounds for
termination would allow servicemembers and their families a
chance to move into military housing.
Several States--and I must commend them: Florida, Georgia,
and Virginia--already have similar laws. We should extend this
opportunity to servicemembers serving anywhere in the United
States or around the globe.
I am proud to have produced this bill with Senators Begich,
Whitehouse, Durbin, and Tester. It is supported by the Military
Officers Association of America and also by the Veterans of
Foreign Wars.
Mr. Chairman and Members of the Committee, thank you for
your important work. Thank you for protecting our veterans. I
look forward to working with you on this legislation.
Chairman Sanders. Senator Reed, thank you very much.
Senator Nelson.
STATEMENT OF HON. BILL NELSON,
U.S. SENATOR FROM FLORIDA
Senator Nelson. Thank you, Mr. Chairman. If I may submit my
written commentary for the record.
Chairman Sanders. Without objection.
Senator Nelson. Mr. Chairman, I am just going to tell you
what the three pieces of legislation are. The first one is a
no-brainer. It is naming the Bay Pines Hospital in the Pinellas
County, Florida after the longest-serving Republican member of
the House of Representatives who we just lost last week, Bill
Young.
His record as Defense Appropriations Chairman, the way he
lived his life, where he and his wife literally adopted a
Marine who was back from the war and have raised him as their
son, and the way that he has reached out to veterans, so much
so that the Florida congressional delegation and I conferred
last week before his funeral while we were still in recess. The
House was in session, and the House took it up and has already
passed it, naming the Bay Pines VA hospital after Bill Young.
That is the first piece; and if you could go all on, if you
all see fit to move that legislation, it would be a timely
thing for the family.
Veterans Conservation Corps. This is for post-9/11 veterans
coming home who are unemployed. They would be employed not
unlike the old CCC, or Civilian Conservation Corps, for up to 1
year with a possible 1-year extension.
It obviously has a price tag of about a couple of billion
dollars. The question is what is the value to society of
employing veterans for worthwhile things in our national parks
and schools, and I can go into as much detail as you want but
that is the idea.
The third piece of legislation is something this Committee
has already pushed; electronic health records coming out of the
Department of Defense, active duty, as they then go into the VA
health care system. Of course, you know the difficulty there so
this tries to set a timeline that is achievable; it tells VA
and the DOD set your goals, set in the milestones, achieve
them, and then have the full implementation of the electronic
health records that will allow a seamless transfer which is
what we all want.
Those are my three pieces of legislation. Thank you, Mr.
Chairman.
[The prepared statement of Senator Nelson follows:]
Prepared Statement of Hon. Bill Nelson,
U.S. Senator from Florida
Chairman Sanders, Ranking Member Burr, thank you for the invitation
to be here today. I'm honored to speak to the Committee about three
pieces of legislation that I've filed to benefit our Nation's veterans.
s. 1576, re-designation of the bay pines va facility to honor
rep c.w. bill young
On Monday, I filed legislation to rename the Bay Pines VA
Healthcare System St. Petersburg, Florida, in honor of Representative
Charles William ``Bill'' Young. I believe this is an appropriate way to
recognize his service to the men and women of our military, the State
of Florida, and the Nation.
Throughout his long career Representative Young was an unwavering
advocate for our Nation's servicemembers and veterans. He served for
nine years in the Army National Guard and a further six as a reservist,
and in 1970 was elected to the House of Representatives. For over 40
years, and as the longest serving Republican in the House, he
represented the needs of the Pinellas County, Florida region, where the
Bay Pines VA Healthcare System is located. His willingness to work
across the aisle to best represent his constituency was commendable and
exemplary of his time in public service.
I strongly support the efforts of the Florida Congressional
Delegation and the legislation to rename the Bay Pines VA Healthcare
System after Representative Young.
s. 1262, veteran's conservation corps
While the economic downturn has taken a toll on most Americans,
it's been especially tough for many of our veterans. According to the
Bureau of Labor and Statistics, the unemployment rate of Post-9/11
veterans is 10.1%, much higher than the national unemployment rate of
7.2%. And with the drawdown in Afghanistan, we can expect newly
separated veterans to enter into the workforce at increasing rates.
Numbers like these tell me we need to do more to help those who
sacrificed in service to our Nation.
This summer, I again filed legislation to authorize a Veterans
Conservation Corps. Modeled on the Civilian Conservation Corps of the
1930s, this jobs-program would put veterans back to work restoring and
protecting America's public land and waters. Veterans have a history of
public service, as well as unique training and skills that could
benefit these national priorities, even after their military service
has come to an end.
Mr. Chairman, not only will this bill help veterans, but the
Veterans Conservation Corps will help address the Federal maintenance
backlog. The National Park Service has a deferred maintenance backlog
of more than $11 billion. Federal public lands are not only National
treasures, but they are also economic drivers, bringing in tourism and
recreational opportunities to local communities. It's been estimated
that for each dollar invested in park operations, $10 in gross sales
revenues are generated, and last year, national parks provided $31
billion of direct economic benefit to local communities around the
country.
The Conservation Corps would be overseen by an inter-agency task
force--bringing together expertise from the Departments of Agriculture,
Commerce, Homeland Security, Interior, the Army Corps of Engineers, and
the Corporation for National and Community Service (CNCS). Of note, I
am pleased to have the support of the Veterans Administration.
It's up to us to stand by our soldiers, sailors, airmen, marines,
and coast guardsmen. Passing legislation to help employ veterans--like
the Veterans Conservation Corps--is the way we can thank them for their
service and bravery.
s. 1296, electronic health records
I would also like to discuss my legislation which addresses
electronic health records and the ongoing efforts by the Department of
Defense and the Department of Veterans Affairs to effectively
communicate with one another. The men and women of our Armed Forces
sacrifice a great deal for this country and while we recognize the need
to provide them with a modern health records system, so far, we have
failed to deliver.
The Departments have been pursuing a cohesive system for over
fifteen years; putting in hundreds of millions of dollars and countless
staff hours, yet the Departments still lack the ability to fully access
servicemembers' health records. The lack of access causes delays,
increases the backlog of claims at the VA, and has the potential to
cause real harm to a servicemember as a result of incomplete or
inaccurate health records.
We must not continue kicking the can down the road while
servicemembers and veterans are subjected to an untenable system. Goals
must be set, milestones achieved, and in the near future, the full
implementation of an electronic health records system that allows for
the seamless transfer of records between the Department of Defense and
Department of Veterans Affairs.
closing
Chairman Sanders, Ranking Member Burr, I appreciate all the work
this Committee has done to honor our Nation's veterans and I look
forward to working with you on these pieces of legislation.
Chairman Sanders. Thank you very much, Senator Nelson.
Senator Franken.
STATEMENT OF HON. AL FRANKEN,
U.S. SENATOR FROM MINNESOTA
Senator Franken. Thank you, Mr. Chairman and Mr. Ranking
Member. I spent the morning with you, too. [Laughter.]
I want to thank you for the opportunity to speak very
briefly about my bill, the Rural Veterans Health Care
Improvement Act; but before Senator Nelson leaves, I want to
associate myself with all three of his.
I think a Conservation Corps for veterans is a great thing,
and I think those health records, obviously those electronic
health records need to be done as expeditiously as possible.
So, I am here to talk about the Rural Veterans Health Care
Improvement Act. I am very pleased to be once again working
with my colleague Senator Boozman on this bill. He is not able
to be here as he is a conferee on the Farm Bill. As I said the
last time I testified here, Senator Boozman's unflappable
demeanor and his commitment to veterans are equally renowned.
Our bill, the Rural Veterans Health Care Improvement Act,
is on a subject that I know the Chairman cares deeply about,
improving the access to quality health care for our Nation's
veterans who live in rural areas and I know actually all the
Members of this Committee care about that.
My State of Minnesota has a disproportionate number of
veterans who live in rural areas and that presents a challenge
for getting quality care through the VA. VA has been working on
this, but there is room for improvement. That is what our bill
would push VA to do.
It would simply tell VA that when it next produces a
strategic plan or updates its strategic plan for rural veterans
health, there are certain key features that strategic planning
has to include, must include.
VA needs to plan strategically about recruiting and
retaining practitioners for rural areas, for instance. It has
to make full and effective use of mobile outpatient clinics. It
has to make sure it is planning for the provision and
coordination of care for women veterans in rural areas.
To talk at a little greater length about another aspect of
our bill, the VA Inspector General has reported numerous times
on challenges faced by veterans in rural areas in getting
emergency care. This is understandable. Many rural clinics are
not equipped to handle many types of emergencies including
mental health emergencies.
We know emergencies will happen and we know they go beyond
the capacity of relatively small clinics. We need to be
prepared and that means that VA has to make sure that rural
health care providers are identifying their clinical capacity
and have a contingency plan for how to handle emergencies that
exceed that capacity.
I know that VA wants to make this work, wants to do this
work and provide the best care possible for rural veterans. I
believe the legislation Senator Boozman and I have put forward
will help the VA do that. Rural veterans deserve excellent
health care no less than their brothers and sisters in urban
settings.
So, thank you very much.
Chairman Sanders. Senator Franken, thank you very much.
Senator Coats.
STATEMENT OF HON. DANIEL COATS,
U.S. SENATOR FROM INDIANA
Senator Coats. Mr. Chairman, I am not sure what you and my
colleagues did this morning. I am sorry I did not get an
invitation. [Laughter.]
It sounds like it was a pretty good gig.
Senator Franken. It was fun.
[Laughter.]
Senator Coats. Mr. Chairman, I regret that I have to be
here to ask you to do something today. Through a mistake made
by the VA and their inability to timely address this issue, we
have a situation that I think needs to be addressed and I am
asking the Committee if you would be willing to support the
bill that I introduced, S. 1471, the Alicia Dawn Koehl Respect
for National Cemeteries Act.
Let me give you just a bit of background. In May 2012, a
veteran, Michael LaShawn Anderson, went on a shooting spree at
an Indianapolis apartment complex, injuring three people and
taking the life of Alicia Dawn Koehl.
Her parents-in-law are sitting behind me from Fort Wayne,
IN. The families have had to go through an excruciatingly
lengthy and unproductive process in trying to right a wrong. A
mistake was made. Federal law does not allow for burial of a
veteran, ``if they have committed a Federal or State capital
crime but were unavailable for trial due to death.'' They are
prohibited from being given the honor of a burial in a National
Cemetery.
To the family's distress, the perpetrator of the crime,
Michael Anderson, was buried in a National Cemetery, Fort
Custer National Cemetery in Michigan. The family has been
asking, since that did violate the law and that is not
something I think we want to continue to promote, that the
remains be disinterred and buried wherever the family of the
person who committed the crime wants to bury them outside of a
National Cemetery.
That mistake, and we are going to call it a mistake, by VA
needs to be corrected. The family is simply asking for closure
and peace of mind that those remains be disinterred. VA's legal
department has basically said they do not have the legal
authority to do that. And so S. 1471 simply gives them the
ability to do that, not only in this case but for potential
future cases.
This process has gone on too long. It has been difficult to
get to this point. We have spent months and months and months
on this. Together, we have worked with VA to fashion this
legislation. I simply am asking for the Committee's support for
this to hopefully expedite it so that we do not have to wait
another year. If it could be done in this Session, I think
justice will be served and the family can find some closure
from this tragic situation.
So, we appreciate your consideration of this. Anything you
can do, colleagues, would be deeply appreciated not just by me
but certainly by the family and all of those loved ones of this
remarkable woman.
I could tell you some amazing things about her. She lost
her life in an unnecessary random shooting that simply took the
lives of people for no reason whatsoever. So, whatever help you
can give us here we certainly would appreciate.
Prepared Statement of Hon. Dan Coats on the Alicia Dawn Koehl Respect
for National Cemeteries Act
Chairman Sanders, Ranking Member Burr, and Committee Members: Thank
you for the opportunity to testify on behalf of S. 1471, the Alicia
Dawn Koehl Respect for National Cemeteries Act. I am pleased to be
joined by Alicia Koehl's father-in-law and mother-in-law, Frank and
Carol Koehl, who traveled from Fort Wayne, Indiana, to be here with us
today for this important hearing. I would like to ask unanimous consent
to include a letter from Alicia's husband, Paul Koehl, in the record.
I truly wish my legislation wasn't necessary. It shouldn't be. I
wish the tragic events of May 30, 2012 never took place and there
wasn't a need for a bill named after Alicia Koehl. I wish the
Department of Veterans Affairs had not made an unacceptable mistake
that resulted in even more pain and heartache for this family.
On May 30, 2012, Michael LaShawn Anderson went on a shooting spree
at an Indianapolis apartment complex, injuring three people and taking
the life of Alicia Dawn Koehl, a devoted wife and loving mother of two
children. Anderson killed himself as police were arriving on the scene.
Shortly after the Koehl family faced the unimaginable--laying to rest
their beloved Alicia--they discovered that the local Department of
Veterans Affairs cemetery officials mistakenly granted the shooter a
burial with military honors at Fort Custer National Cemetery in
Augusta, Michigan on June 6, 2012.
After learning that Anderson was buried alongside our country's
heroes in a national cemetery, the Koehl family requested that the VA
disinter his remains. Federal law prohibits individuals who ``have
committed a Federal or state capital crime but were unavailable for
trial due to death'' from being given the honor of a burial in a
national cemetery.
For over a year, my staff and I have been working with the VA and
the Koehl family to remove Anderson's remains from the Fort Custer
National Cemetery in Michigan. However, earlier this year, the VA
informed me personally that it will not disinter the remains of
Anderson because the department does not believe it has the legal
authority to take this action. In other words, the VA was not permitted
under current law to bury Anderson at a national cemetery, but the
department doesn't believe they have the legal authority to fix its own
mistake and exhume the remains of an ineligible veteran.
My legislation (S. 1471) would right this wrong by granting both
the Department of Veterans Affairs and the Department of Defense the
authority to disinter veterans buried in national cemeteries who commit
a Federal or state capital crime. This bill would give the VA the
authority it needs to exhume the remains of Michael LaShawn Anderson.
I urge support for this important legislation. The victims and
family members of this tragic shooting have suffered enough and do not
deserve to have to wait another year for their request met. No one who
commits a state or capital crime should be given the honor of a
military burial and be laid to rest next to our Nation's military
heroes. By passing this legislation, we can resolve an unacceptable
mistake and help provide the Koehl family with a sense of peace and
closure. I urge this Committee to pass the Alicia Dawn Koehl Respect
for National Cemeteries Act to ensure that our fallen veterans can rest
in peace next to loved ones and fellow servicemembers, not criminals.
Thank you.
Chairman Sanders. Senator Coats, we will certainly take a
very hard look at that. We thank you for bringing this to our
attention and we very much thank the family for being here as
well. We appreciate that.
Senator Heinrich.
STATEMENT OF HON. MARTIN HEINRICH,
U.S. SENATOR FROM NEW MEXICO
Senator Heinrich. Chairman Sanders, Ranking Member Burr,
and Members of the Committee, I want to thank you all for the
opportunity today to speak about S. 1148, the Faster Filing
Act. I was glad to introduce this bipartisan bill with Senator
Dean Heller to my left, a Member of this Committee, in order to
help reduce the disability claims backlog.
By now, I think every veteran and most Americans have heard
of the unacceptable backlog facing our Nation's veterans but
not every veteran is aware of a faster filing option to reach a
decision quicker and to help avoid the backlog altogether.
As this Committee is aware, the VA's fully developed
claims, or FDC, program has allowed servicemembers, veterans,
and survivors to reach faster decisions from the VA on
compensation, pension, and survivor benefit claims.
Together in partnership with our Nation's dedicated
veterans service organizations, regional offices like the one
in Albuquerque, NM, are working hard to promote fully developed
claims and break the backlog.
On average, it takes 113 days for veterans to receive a
final disability rating if they file a fully developed claim
online. Compare that with 373 days if they file a non-fully
developed claim on paper.
Specifically, this bill seeks to ensure that veterans are
aware of the fastest options that are available to them. It
simply does so by requiring the VA to provide notice about the
differing processing times of disability claims based on the
manner in which the veteran files from an electronic fully
developed claim to a non-fully developed claim on paper. This
notice would occur prominently on the VA Web site and in each
regional office and claims intake facility at the VA.
I am pleased to know that VA has already taken a number of
steps since this bill's introduction that are consistent with
the intent of the legislation, but more can be done to
encourage veterans to submit their claims in the most efficient
way possible and this bill is one way to do that.
I also understand there are some suggestions for improving
this bill and I certainly look forward to working with the
Committee, the VA, and the VSOs to see this bill enacted into
law.
Once again, I would like to thank my colleague, Senator
Heller, for his help with this legislation.
Chairman Sanders. Senator Heinrich, thank you very much.
I think we have heard from all of the Senators who are not
on the Committee so let us get some opening remarks from
Members of the Committee. We will begin with Senator Tester.
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Mr. Chairman and Ranking Member Burr, I
very much appreciate your having this hearing today and thank
the VA witnesses, MOAA, VVA, and DAV for participating in this
hearing and supporting my legislation. I want to speak briefly
about a few bills that I have.
We all know Montana is a rural State. The distance between
communities are long. Quality mental health care can be hard to
find. The lack of qualified mental health clinicians is a big
problem for rural veterans and Montana is no exception,
especially for those returning from Iraq and Afghanistan with
unseen wounds like PTSD and TBI. Too many living in rural
communities go untreated and they pay the price for it.
Improving mental health care in rural America means
expanding the use of telemedicine. It means making sure that
veterans get the care they need during demobilization. It means
improving the VA's use of information technology.
I have introduced the Rural Veterans Mental Health Care
Improvement Act this year to tackle these issues. This bill
addresses one more critical problem, the lack of qualified
mental health professionals working for the VA in rural parts
of this country.
I introduced this bill after we held a hearing to highlight
the problem and look for solutions. The hearing revealed that
not only are there not enough mental health professionals
dedicated to working with rural veterans but all too often
government agencies are not on the same page when it comes to
providing needed care.
The bill also requires the VA to include licensed
professional mental health counselors and marriage and family
therapists in the Department's flagship recruitment program,
the Health Professionals Trainee Program.
These counselors and therapists make up to 40 percent of
the overall independent practice out there in the behavioral
health workforce nationwide and they often practice in rural
areas. But the VA employs fewer than 200 of them in its
behavioral health workforce that numbers more than 23,000. That
should change.
By bringing more counselors and therapists into the VA's
leading health professional training program and providing them
with a stipend, more of these professionals will join the VA
and make a difference in the lives of America's veterans. With
your support, this will become law and more rural veterans,
whether in Montana, Alaska, or anywhere in-between, will get
the care that they need.
The second bill, S. 1165, would expand performance measures
to the entire list of VA and CDC recommended adult
vaccinations. This would promote timely and appropriate
vaccinations while placing a greater emphasis on preventable
care for our veterans.
Each year approximately 70,000 adults die from vaccine
preventable diseases. Influenza alone is responsible for 1
million ambulatory care visits, 200,000 hospitalizations, and
30,000 deaths. Vaccinations are one of the safest and most
cost-effective ways to prevent disease and death.
To ensure that they are administered in a timely and cost-
effective manner, the CDC has recommended an adult immunization
schedule that is periodically reviewed and revised. This bill
would ensure veterans receive each immunization on the
recommended adult immunization schedule established by the CDC.
Finally, the last bill would simply allow the VA to provide
dependency and indemnity compensation, DIC, and death pension
benefits to the widows of fallen servicemembers and veterans
for up to 6 months.
By law, a surviving spouse has to file a claim with the VA
before receiving DIC or death pension benefits. Though the
majority of DIC and death pension claims will be granted
automatically once a claim is filed, the widow loses the
veterans benefits immediately upon the veteran's death.
For the most part, these are poverty-level widows. So, in
the midst of an incredibly difficult time--we have heard this
before--these widows are faced with financial hardship until
they file a claim and it is processed. The families of our
fallen heroes must be given time to mourn without worrying
about how to make ends meet.
Finally, Mr. Chairman, and this is entirely up to you, I
heard Senator Nelson's bills. He had three of them. One had to
do with the Bill Young naming of a clinic. I think it is
entirely possible to get that bill out today, to get it to the
floor, get it hot-lined, and move along with that in the short
term.
Thank you, Mr. Chairman. I very much appreciate the
opportunity to speak. Thanks.
Chairman Sanders. Thank you, Senator Tester.
Senator Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator Johanns. Thank you, Mr. Chairman. Thanks for
holding this hearing. I do appreciate the opportunity to share
a few words on a bill that I have introduced with one of our
colleagues from Colorado, Senator Bennet.
I have joined with Senator Bennet in introducing S. 1216.
We call it the Improving Job Opportunities for Veterans Act of
2013. This legislation seeks to expand opportunities for
veterans using GI Bill benefits to participate in on-the-job
training programs and apprenticeship-type training programs.
It would encourage private employers to hire veterans by
increasing the VA's contribution to the veteran's salary during
the training. It would also help ensure Federal agencies are
utilizing the on-the-job training and apprenticeship training
benefit to hire veterans.
I believe, and I think Senator Bennet believes, that
increasing job opportunities for veterans by ensuring that
veterans have the ability to participate in on-the-job training
and apprenticeship training programs upon leaving active duty
is critically important and this could be a difference maker.
The men and women who have served our great Nation have
given a lot. This is one way of helping them out when they
return home. As they seek to transition to civilian careers, I
believe that this bill will help them make that transition.
I might mention that this legislation overwhelmingly passed
the House in May actually by a vote of 416 to 0. So, I would
appreciate your consideration of this legislation. I ask my
colleagues to join me in supporting it. It is my hope that we
can get the bill done.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Johanns.
Senator Hirono.
STATEMENT OF HON. MAZIE HIRONO,
U.S. SENATOR FROM HAWAII
Senator Hirono. Thank you, Mr. Chairman, for holding this
hearing today to receive testimony on more than two dozen bills
to help our veterans. These bills do a lot of good, from
improving dental health services and making mental health
services available to veterans and their families, to
strengthening job training programs for men and women in
uniform.
In particular, I wanted to highlight Chairman Sander's
bill, S. 1581, to authorize VA to provide counseling and
treatment for military sexual trauma for active-duty
servicemembers. This bill will help survivors of sexual assault
get the care they need.
I also want to express my support for Senator Durbin's
bill, S. 1559. This legislation will ensure that U.S. residents
who are Filipino World War II veterans receive the full
benefits that they have earned through their service.
We owe all servicemembers and veterans, no matter when and
where they served, the care they need and the benefits they
have earned, and these measures would help fulfill that
commitment.
Finally, I would like to speak for a few moments on
S. 1588, a bill that I introduced along with Senators Moran,
Isakson, and Begich. This bill provides an emergency safety net
to 144,000 veterans waiting for VA care. This bill fixes a
Catch-22 in current law that puts veterans who have recently
returned from overseas at financial risk if they experience a
medical emergency.
Under current law, a veteran enrolled in the VA system who
receives emergency care at a non-VA facility can be reimbursed
for those costs only if the veteran has also received care at a
VA facility in the preceding 24 months.
As I understand it, the intent of this requirement is to
encourage veterans to seek preventative care at least every 24
months to decrease the need for more expensive emergency care.
This 24-month requirement creates a problem for some newly
returned veterans. They cannot comply with this requirement
through no fault of their own. Newly returned veterans cannot
comply because they have not received their first VA
appointment because of VA waiting times. But, if they need to
go to a non-VA hospital for a medical emergency, the VA cannot
reimburse them because they have not received their first VA
appointments. A Catch-22.
My bill fixes this problem for newly-returned veterans.
This bill gives VA the flexibility to reimburse veterans who
have not yet received their new patient examination if they
have to go to a non-VA hospital for a medical emergency.
For Hawaii, veterans in rural Oahu or on the neighbor
islands who live far from VA facilities, emergency care outside
the VA may be their only option. Just last week I met a veteran
from Waianae, on Oahu, who had a medical emergency while
waiting 4 months for his first appointment at VA.
Veterans like him who are denied VA reimbursement would get
much-needed relief under this legislation. We owe it to our
brave men and women in uniform who put their lives on the line
for our country, that VA has the tools it needs to better serve
our new veterans accessing the care they have earned.
I look forward to hearing from our witnesses and their
thoughts on this and the other bills.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you very much, Senator Hirono.
Senator Isakson.
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Well, thank you, Mr. Chairman, and I
associate myself with all of the remarks by Senator Hirono with
regard to her bill on emergency medical services. I think it is
a great bill. I am an original cosponsor and completely support
it.
I also would urge the Chair to also consider, if it is not
inappropriate for me to do so, to consider Senator Tester's
request with regard to a UC, or unanimous consent, on the bill
naming the veterans facility after Bill Young. Bill was an
outstanding member of the Appropriations Committee for 40 years
in the House of Representatives, and passed away last week. I
think it is an appropriate and fitting tribute.
Also with regard to Senator Tester's legislation, he has
one bill on widows' benefits that says that they get paid
immediately upon filing but before they have been approved
which is fine with me, but there are cases where sometimes
benefits, death benefits, of veterans are contested, where you
have more than one spouse in the past.
Having dealt with that in the past, the bill needs to have
a reimbursement provision where if it ultimately was denied,
the VA is reimbursed for that. That is the only suggestion I
would make on that.
Last, Senator Coats from Indiana's presentation with regard
to the burial in the cemetery in Michigan, I think that also
merits expedited attention.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you very much, Senator Isakson.
Senator Blumenthal.
STATEMENT OF HON. RICHARD BLUMENTHAL,
U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. Thank you, Mr. Chairman, and thank you
for having this hearing.
I want to begin by speaking about a U.S. Marine from
Connecticut who unfortunately and tragically took his own life
yesterday. I spoke about his tragic loss on the floor of the
Senate earlier today.
Justin Eldridge served on active duty in the Marine Corps
for 8 years and came back to begin another battle with post
traumatic stress and traumatic brain injury. He fought hard. He
fought bravely. He fought with the full support of his family,
particularly his wife Joanna and his four children; and
unfortunately he lost that battle.
I first came to know him when he formed a chapter of the
Marine Corps League in southeastern Connecticut and recruited
me to join, and I knew him as a dedicated Marine committed to
helping his brothers and sisters in the Marine Corps and as a
loving husband and father.
We will miss him in Connecticut and I think in the country.
But his story shows the importance of the work that we are
doing on this Committee today because, as he would be the first
to say, there are thousands and thousands like him who are
engaged in the same battle, in the same struggle whom we are
seeking to help today right here. So, it provides a context and
a special meaning for me today.
Turning to the legislation before us, I want to thank all
of the witnesses who are going to be with us today for their
testimony. It is very, very important that you give us the
insight and the benefit of your perspective. I thank you for
your service to our Nation as well as your being here today and
your contribution to many, many veterans across the country.
One of this Committee's, and indeed the Senate's top
priority, should be eliminating the backlog of veterans claims.
I appreciate the VA's commitment to eliminating that backlog
and welcome some of the recent positive news that the backlog
is declining but unfortunately we are nowhere near where we
should be yet and we have to remain vigorous and vigilant in
ensuring that the backlog continues to decrease to zero even
before the projected date by General Shinseki.
No veteran should have to wait months and months or even
years to receive a decision from the VA. Again, taking
Connecticut as an example, I recently learned of veterans whose
disability claims were approved literally at the beginning of
October at a 2-year wait and then had to wait again because of
the shutdown to have the full satisfaction and security of
knowing that they would receive the disability claims to which
they were entitled.
I am proud to cosponsor and support the Servicemembers
Electronic Health Records Act. I introduced this bill as an
amendment during the Committee's markup in July and I will
continue to work to enact it into law.
This bill would require the VA and the Department of
Defense medical records to be interoperable in order to create
a seamless transition when a servicemember leaves active duty
and becomes a veteran and also to allow easy access to VA
officials who need a veteran's medical records to decide a
veterans claim.
There are two other bills that I have introduced which I
will briefly state without going into detail. The first is
S. 1281, the Veteran Servicemembers Employment Rights and
Housing Act, which I developed with AMVETS and am proud to have
the support of the VFW, as well, for this bill. It would
include veterans as a protected group in the Equal Employment
Opportunity Law and the Fair Housing Act.
Another bill that I introduced actually yesterday, the
Toxic Exposure Research and Military Family Support Act, I was
pleased to do with the support and tremendous contributions of
the Vietnam Veterans of America. This is a comprehensive effort
to provide for veterans who were exposed to danger us toxic
substances during their military service and for their loved
ones.
We have seen alarming trends in children of veterans
exposed to Agent Orange. Many have childhood cancer, heart
attacks or other serious conditions. This bill is really an
attempt to have the VA look at each incident of toxic exposure
in the military on its own merits and its own facts to
determine the effect on veterans and their dependents.
I am working with a variety of VSOs on this legislation and
other legislation which I support, including S. 1211, which
would ensure that the phrase ``GI Bill'' cannot be used under
false pretenses; and the World War II Merchant Mariner Service
Act which affects many of our constituents who served our
country honorably during World War II in the Merchant Marines
and deserve treatment under this bill.
I also would like to be added as a cosponsor and supporter
of S. 1262, Senator Nelson's Conservation Corps Bill; S. 1155,
Senator Tester's Rural Mental Health Act.
I thank you, Mr. Chairman.
Chairman Sanders. Thank you very much, Senator Blumenthal.
Senator Heller.
STATEMENT OF HON. DEAN HELLER,
U.S. SENATOR FROM NEVADA
Senator Heller. Thank you, Mr. Chairman. Thank you and the
Ranking Member for holding this hearing. Before I begin, I want
to thank you for your opening comments about bipartisanship
which, in these halls it is hard to find sometimes and I think
the work that you and Senator Burr do together moves this
Committee forward.
For someone watching what is going on both sides, both
chambers on the floor, it is a breath of fresh air. So, thank
you very much for your leadership on that.
I want to also thank Senator Isakson and support him in his
request to move Senator Nelson's and Senator Coats' request. I
think that would be appropriate and I cannot imagine there
would be any opposition.
I would like to focus my remarks on the VA's disability
claims backlog. When I joined this Committee, I made it one of
my top priorities to bring the backlog of claims down and
joined Senator Casey to establish the VA Backlog Working Group.
All parties have acknowledged the gravity of this problem.
I continue to work with veterans service organizations and
other members of Congress and the VA to address this particular
problem.
Hundreds of Nevada veterans and their family members in Las
Vegas and Reno have come to my office to express their
frustration with wait times and to seek assistance navigating
through this very difficult process.
During roundtables in Nevada's communities, veteran
advocates told me that the VA backlog has directly impacted the
welfare of these individuals. While the VA has made progress
toward reducing the backlog, the Reno VA regional office still
has more than 4,000 veterans that have waited over 125 days for
decisions on their claims.
This is a problem that I know we all want to fix.
Democrats, Republicans, the President, Secretary Shinseki are
all concerned about this issue and want to see it solved.
It is clear that we need to do more to fix this problem and
to fix it permanently. That is why I have joined with Senator
Heinrich to introduce bipartisan legislation that gives
veterans information about the timeliness of the fully-
developed claims program.
The Veterans Benefits Claims Faster Filing Act ensures that
veterans are fully informed of the filing options available to
them. The VA will be required to provide information online and
in each VA regional office about which options will result in a
quicker decision.
When veterans submit a fully-developed claim with all
evidence ready for the claims process, the claim is completed
in less than 125 days on average, meeting the VA's deadline
before a claim becomes backlogged. However, claims that are not
fully developed often take more than a year to process.
Providing accurate information to veterans before they submit a
claim will save time for both the veteran and the VA
themselves.
The VA would also be required to inform veterans that
filing a fully-developed claim makes them eligible to receive
an additional year of benefits as authorized under current law.
It is important that veterans are encouraged to file a fully-
developed claim so that fewer individuals experience the
frustration of waiting for benefits they have earned in service
to our country.
While there is no single bill that will magically reduce
the backlog, I believe that targeted legislation like Senate
Bill 1148 takes us another step forward to helping our Nation's
veterans and the VA reach this goal. I do appreciate Senator
Heinrich's remarks on our legislation and look forward to
working with him to move this bill forward.
Mr. Chairman, I would also like to express my support for
Senator Tester's bill, the Military Family Relief Act, which I
am proud to be a cosponsor of. This legislation authorizes the
Veterans Benefits Administration to automatically and
immediately provide death and indemnity compensation and death
pension benefits to widows and widowers of fallen
servicemembers and veterans.
Currently, widows and widowers are not eligible to receive
these needed benefits until they file a claim and it is
approved. The process can take months. At a time when a family
is grieving over the loss of a loved one, these individuals
should not also feel burdened by the financial strain of having
to wait several months for these benefits. I am glad to support
Senator Tester in this effort and hope to see it move forward.
As this Committee further discusses proposals to help
American veterans receive the benefits they have earned, it is
my hope that we will remember our commitment to caring for
these brave heroes who have sacrificed greatly to serve this
country.
Thank you very much, Mr. Chairman.
Chairman Sanders. Thank you, Senator Heller. I think we
have now heard from all of the sitting Members of the Committee
and we are ready for our first panel.
We thank our panelists very much for being with us this
afternoon. From the Department of Veterans Affairs, we have Dr.
Robert L. Jesse, the principal Deputy Undersecretary for
Health. Dr. Jesse, thanks for being here.
Also joining us today from VA is David McLenachen, the
Director of the Pension and Fiduciary Services for the Veterans
Benefits Administration, and we thank you very much for being
here.
Rounding out this panel are Assistant General Counsel
Richard Hipolit and Deputy Assistant General Counsel Jane Clare
Joyner.
The Department's full statement will be entered into the
record.
Dr. Jesse, please begin.
STATEMENT OF ROBERT L. JESSE, M.D., Ph.D., PRINCIPAL DEPUTY
UNDER SECRETARY FOR HEALTH, U.S. DEPARTMENT OF VETERANS AFFAIRS
Dr. Jesse. Thank you, sir. Good afternoon, Chairman
Sanders, Ranking Member Burr, and Members of the Committee and
thank you for the opportunity to be here today.
Sir, I very much appreciate your positive comments about
both the quality and value of VA health care and your
admonishment to the timeliness of our formal views. Noted, and
we will make sure that word is carried back.
We appreciate very much the efforts of the Committee to
improve veterans' health care. As you have already stated, with
the number of bills on the agenda, we are really only today
able to have some very broad comments before fielding your
questions.
There are a number of more significant bills I think we
received really too late to include in the testimony but I want
to assure you that we will be following up with a substantive
discussion.
As you know, one of Secretary Shinseki's top priorities is,
in fact, access for veterans. That includes access into the
system in a timely fashion which is much of the issue with
getting into the benefits system but also access to timely and
quality health care within our side of the system.
We have been very aggressive about getting access to care
close to where veterans live through aggressive outreach as
well as through the use of telehealth, connected health
strategies.
There are significant bills on the agenda that aim at
expanding access to health care services as well as dental
care. The agenda also includes bills on the important topics of
our care for victims of military sexual assault and domestic
violence as well as expanding mental health support and the
promising alternatives to institutional care across the health
care spectrum.
We do appreciate the dialog that we have had with your
staff, especially regarding the draft bill on eligibility and
access. There are some operational complexities that we note in
our written testimony. We also believe that there are some
provisions in there that are intertwined with the Affordable
Care Act and will take a little more time to work out through
coordinating with partners in departments of Health and Human
Services and Treasury.
Again, I want to be very plain that the VA, the Secretary,
no one wants more than to ensure access to and quality of care
at the VA, but we do need to be mindful of both current
capacity within the system and the effect that any eligibility,
significant eligibility changes might have on the services we
have already committed to veterans under our care.
A number of these bills, many of these bills we, in fact,
whole-heartedly agree with in terms of concept and direction
and intent; some of which, however, we think we are already
doing under current authorities and it may be well served by
improved communication.
This includes S. 1165 regarding immunizations; S. 1411,
defining the components of the strategic claim for rural
health. We have a comprehensive approach of addressing both of
these topics already.
Regarding S. 1547, VA plans to fully brief the Committee on
the results of the dialysis pilot program before we expand into
any additional freestanding dialysis clinics, and I do wish to
assure the Committee that we are actively evaluating the data
from the pilots as they are being generated, and we intend to
render an expansion decision only after that has been fully
understood.
Our concern is that this bill would, as it states, prevent
us from activating any further freestanding dialysis centers
until after July 2015 because the last center did not get
operational--that is the one in Cleveland, OH--until after in
July 2013.
That is the main reason we are not supporting the bill, but
we would like to continue to work with the Committee to ensure
that we are taking all steps possible to maintain and ensure
future access to effective dialysis care for veterans.
That concludes my oral statement. I will turn to my
colleague Dave McLenachen, who will comment briefly on the
other bills on the agenda.
STATEMENT OF DAVID R. McLENACHEN, DIRECTOR, PENSION AND
FIDUCIARY SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY RICHARD HIPOLIT,
ASSISTANT GENERAL COUNSEL; AND JANE CLARE JOYNER, DEPUTY
ASSISTANT GENERAL COUNSEL
Mr. McLenachen. Thank you, Dr. Jesse.
Good afternoon, Mr. Chairman, Members of the Committee. I
am also pleased to have the opportunity to comment on the bills
before the Committee today and like Dr. Jesse, in the interest
of time, I will keep my comments brief.
As he also noted, bills not covered in our written
testimony will be addressed in our follow-up views. That
applies to the Veterans Benefits Administration bills that did
not make our testimony. We will provide those to the Committee
as soon as possible.
Mr. Chairman, we appreciate the Committee's partnership as
we work to meet the Secretary's goals to reduce our disability
claims backlog while maintaining a high standard of quality. We
also appreciate the introduction of two bills, S. 1148 and
S. 1295 regarding the information that VA provides to claimants
and the public.
The availability of VSO assistance and performance metrics.
We agree with the concepts presented in these bills but feel
that VA has been successful in furthering the aims of the bills
under current law.
While we support veterans having access to good information
and establishing a method for stakeholders and the VA to
measure our progress, these bills may have unintended
consequences. We welcome the opportunity to work with the
Committee to address our concerns.
We appreciate the introduction of draft legislation that
would modernize the actuarial basis for our service-disabled
veterans insurance program. This change is overdue and would
provide greater financial security for our disabled veterans
and their families to lower insurance premiums, provided that
there are corresponding offsets to fund the proposed amendment.
We also support and appreciate bills on the agenda that
would enhance our on-the-job training authorities and help
protect veterans from those who misrepresent that they are
acting as the VA's endorsement when they promote services
associated with post-9/11 GI Bill.
We were also pleased to see S. 1262 on the agenda which is
a measure to provide job opportunities for veterans in
conservation, first responder, and a law enforcement fields
which is similar to the Administration's Veterans' Job Corps
proposal.
VA also supports S. 1471 which would give the Secretary
authority to address those rare cases that you heard about
today in which a National Cemetery buries a veteran without
notice that the veteran may have committed a capital offense.
Finally, VA appreciates this Committee's continued efforts
on our outreach. We agree with the importance of partnerships
with other Federal agencies, State and local officials, and
nonprofits to inform veterans and their families about the
benefits that they have earned. Our testimony includes examples
of how we are meeting the goals expressed in S. 1558.
Mr. Chairman, this concludes my oral statement. My
colleagues and I are happy to answer any questions that in the
Committee may have.
[The joint prepared statement of Dr. Jesse and Mr.
McLenachen follows:]
Prepared Statement of Robert I. Jesse, M.D., Ph.D., Principal Deputy
Under Secretary for Health and David R. Mclenachen, Director, Pension
Fiduciary Service, Veterans Benefits Administration, U.S. Department of
Veterans Affairs
Good Morning Chairman Sanders, Ranking Member Burr, and Members of
the Committee. Thank you for inviting us here today to present our
views on several bills that would affect Department of Veterans Affairs
(VA) healthcare and benefits programs and services. Joining us today
are Richard Hipolit, Assistant General Counsel, and Jane Clare Joyner,
Deputy Assistant General Counsel.
VA is still in the process of formulating views on the following
bills for which VA received notice or drafts on September 30, 2013:
Sections 3-5 of S. 1155, S. 1296, S. 1540, S. 1556, and S. 1559. We
will forward the views and estimates to the Committee as soon as they
are available. Other bills were provided to VA at various points during
the month of October. VA also will provide views and costs to the
Committee on those bills at a later time: S. 1573, supplemental
analysis to what is presented in this testimony regarding the draft
bill entitled the ``Veterans Health Care Eligibility and Expansion
Act,'' views and costs on the draft bills entitled ``Mental Health
Support for Veterans Families and Caregivers,'' the ``Survivors of
Military Sexual Assault and Domestic Abuse Act,'' the ``Medical Foster
Home Act,'' and a draft bill regarding eligibility for emergency
medical treatment.
Additional bills provided to VA during October for which views will
be provided for the record are: draft bills entitled the ``Enhanced
Dental Care for Veterans Act,'' the ``Improved Compensation for Hearing
Act,'' the ``SCRA Enhancement and Improvement Act,'' the ``Ensuring
Safe Shelter for Homeless Veterans Act; the ``Servicemember Housing
Protection Act,;'' the ``Support for Joint Federal Facilities Act, '' a
bill to re-designate the name of a VA Medical Center, a bill regarding
replacement automobiles for certain disabled veterans, a bill
concerning the health conditions of descendants of Veterans exposed to
toxic substances during service in the Armed Forces, and finally a bill
concerning infectious disease reporting and the organizational
structure of VHA.
s. 1148--veterans benefits claims faster filing act
Section 2(a) of S. 1148, the ``Veterans Benefits Claims Faster
Filing Act,'' would require VA to post in a conspicuous place in each
regional office and claims intake facility and on VA's internet Web
site information concerning the average processing times for claims
based on various formats in which a claim can be submitted, and
information concerning the percentage of claims for which benefits are
awarded, categorized by whether the claimant was represented by a
Veterans Service Organization (VSO), a representative other than a VSO,
or not represented via a durable power of attorney. The bill would
require such information to be updated at least quarterly. Section 2(b)
of the bill would require VA to provide each claimant with the same
information. Section 2(b) would further require VA to notify each
claimant that he or she may become eligible for up to one extra year of
benefit payments by submitting a fully developed claim (FDC). The
notice required by section 2(b) would have to be provided before the
recipient submits a claim.
VA understands and appreciates the importance of transparency and
the need to keep Veterans, Congress, and other stakeholders informed.
There are currently many ways for Veterans, VSOs, and others to get
information and data about claims. For example, information is included
in our annual budget request to Congress, the Annual Benefits Report,
the annual Performance and Accountability Report, monthly ASPIRE
updates, monthly Congressional Tracking Reports, the Monday Morning
Workload Report, various Veterans Benefits Administration (VBA) Web
sites (including www.eBenefits.va.gov), responses to calls at our
National Call Centers, and other responses to specific requests from
Members of Congress, stakeholders, and the media.
VA does not support this bill, for several reasons. The bill would
create a significant administrative burden that would effectively delay
the processing of disability compensation claims. The requirement that
VA provide certain information to each claimant potentially would
require VA to revise a number of forms and would implicate the
requirements of the Paperwork Reduction Act, requiring two periods of
public notice prior to changing the form. VA currently provides notice
on FDC forms stating that the FDC program is the fastest way to receive
a decision on a claim. Soon, VA will be revising the notice to inform
claimants of the potential entitlement to an extra year of benefit
payments for original FDC claims.
VA has concerns about the complexity of data that would be required
based on the bill. Some of the metrics outlined in the bill are not
currently available in VA systems. For example, VA generally does not
routinely track grant rates for particular types of claims or whether
claims are submitted in standard or non-standard paper form. Similarly,
the term ``for which benefits are awarded,'' as used in section 2(c) of
this bill, is ambiguous. Awards of service connection for a disability
evaluated at zero percent do not result in payment. Disability
compensation claims can involve a single disability contention or
multiple contentions, and several claims from the same individual may
simultaneously await resolution. It is unclear whether VA would be
required to report awards per claimant, per claim, or per individual
contentions within each claim.
The complex data that would be provided under the bill could easily
mislead or confuse claimants rather than help them understand what they
should do to support their claims. Providing this type of information
could be seen as directing claimants to file, or not file, certain
types of claims or to elect a particular type of representative.
However, the data provided may not be the best indicator of the most
appropriate course of action for the particular claimant. Also,
reporting the percentages of claims with a power of attorney naming a
VSO may be misleading, as Veterans with authorized VSOs often file
claims without the direct involvement of their designated VSOs.
Furthermore, most powers of attorney used to authorize claim
representatives are not ``durable.''
VA also notes that H.R. 1148 does not specify which VA benefit(s)
would be impacted by this bill. Although VA believes the bill is likely
intended to apply to claims for service-connected disability
compensation, the bill does not explicitly state this and would
therefore apply to all benefits. Further, although the bill would
require VA to notify each claimant of the availability of an extra year
of benefit payments if a person files a FDC, section 506 of Public Law
112-154, which authorizes a one-year retroactive payment for persons
who file FDCs, applies only to original (i.e., initial) claims by
Veterans for disability compensation. Providing notice of the
retroactivity provision to persons claiming other benefits, or to
Veterans attempting to reopen disability compensation claims or to
claim increased compensation, may be confusing and misleading. In
addition, the FDC retroactivity provision has a sunset date, while the
bill would require in perpetuity notice of the availability of the
benefits.
VA estimates that there would be no benefit costs associated with
enactment of S. 1148. VA estimates the general operating expenses (GOE)
for section 2 of S. 1148 would be $5.5 million in the first year, $27.7
million over five years, and $58.8 million over ten years. VA estimates
the information technology (IT) costs for section 2 of S. 1148 would be
$122,000 in the first year, $655,000 over five years, and $1.4 million
over ten years.
s. 1155--rural veterans mental health care improvement act
Section 2 of S. 1155 would amend section 117(c) of title 38, United
States Code, to add accounts providing funds for information
technology, including subaccounts of the medical services, medical
support and compliance, and medical facilities accounts, to the list of
accounts in section 117 that receive advance appropriations.
We appreciate how Congressional support for VA advance
appropriations for our medical care accounts has enabled a multi-year
approach to medical budget planning and ensured continued medical
services for Veterans. The advance medical care appropriation was
designed to ensure continuity of critical medical operations in the
face of fiscal uncertainty.
A proposal to expand VA advance appropriations to other accounts
needs to take into consideration the advantages and disadvantages of
such an approach not only for VA, but potentially other programs and
agencies. We cannot therefore offer a position on section 2 of S. 1155
at this time. We very much appreciate the concern for Veterans services
reflected in the proposal, and look forward to working with the
Committee on how to best maintain the provision of VA benefits and
services in light of fiscal uncertainties.
We are finalizing our views and costs on sections 3-5 of S. 1155.
We will forward the views as soon as they are available.
s. 1165--access to appropriate immunizations for veterans act of 2013
S. 1165 would amend section 1701of title 38, U.S.C., to include
certain adult immunizations as part of the preventive services detailed
in subsection 9 of the statute. The bill would also amend section 1706
of title 38, U.S.C., to require VA to develop quality measures and
metrics to ensure that Veterans receiving medical services also receive
the immunizations.
VA strongly supports preventive care measures, including making a
wide range of immunizations available at VA medical facilities.
However, because we believe VA is already satisfying the purpose of
this bill, we do not support this legislation.
Under current policy, VA already provides preventive immunizations
at no cost to the Veteran. In addition, VHA is represented as an ex-
officio member of the Advisory Committee on Immunization Practices
(ACIP) and VA develops clinical preventive services guidance statements
on immunizations in accordance with ACIP recommendations (VHA Handbook
1120.05). All ACIP-recommended vaccines are available to Veterans at VA
medical facilities. These vaccines currently include: hepatitis A,
hepatitis B, human papillomavirus, influenza, measles/mumps/rubella,
meningococcal, pneumococcal, tetanus/diphtheria/pertussis, tetanus/
diphtheria, varicella, and zoster. As the ACIP recommendations change,
VHA policy reflects those changes.
The delivery of preventive care including vaccinations has been
well established in the VHA Performance Measurement system for more
than 10 years with targets that are appropriate for the type of
preventive service or vaccine. VA updates the performance measures to
reflect changes in medical practice over time. Adding the additional
legislative process of regulations to the development of targets would
be burdensome and lengthy.
Moreover, the legislative process does not allow for nimble changes
as new research or medical findings surrounding a vaccine come to
light. Because the clinical indications and population size for
vaccines vary by vaccine, blanket performance monitoring of all
vaccines can be cost prohibitive and may not have a substantial
positive clinical impact.
s. 1211--regarding the use of the phrases ``gi bill'' and ``post-9/11
gi bill''
S. 1211 would amend chapter 36 of title 38, United States Code, to
add a new section 3697B, which would prohibit, except with the written
permission of the Secretary, the use of the words and phrases ``GI
Bill'' or ``Post-9/11 GI Bill'' in connection with any promotion,
goods, services, or commercial activity in a manner that reasonably and
falsely suggests that such use is approved, endorsed, or authorized by
VA or any component thereof. A determination that the use of one or
more words or phrases covered by section 3697B does not violate that
section could not be based solely on the ground that such use includes
a disclaimer of affiliation with VA or any VA component. S. 1211 would
authorize the Attorney General of the United States to initiate a civil
proceeding in a district court to enjoin an existing or potential
violation of section 3697B. Further, S. 1211 would specify that the
district court could, at any time before final determination, enter
such restraining orders or prohibitions, or take such other action as
is warranted, to prevent injury to the United States or to any person
or class of persons for whose protection the action is brought.
VA supports this bill. VA has already taken action to prevent the
misuse and misrepresentation of the phrase ``GI Bill.'' The phrase ``GI
Bill'' is a trademark owned by VA and registered with the U.S. Patent
and Trademark Office as of October 16, 2012. If this bill were enacted,
it would assist in further diminishing aggressive advertising toward
Veterans, as addressed in Executive Order 13607: Establishing
Principles of Excellence for Educational Institutions Serving
Servicemembers, Veterans, Spouses and Other Family Members.
VA estimates there would be no costs to VA associated with
implementing this bill because, according to the bill text, the
Attorney General's office would be responsible for enforcing the
prohibition. If VA was notified of, or became aware of, prohibited use
of the phrases ``GI Bill'' or ``Post-9/11 GI Bill,'' VA would refer the
incident to the Department of Justice (DOJ).
s. 1216--improving job opportunities for veterans act of 2013
Section 2 of S. 1216, the ``Improving Job Opportunities for
Veterans Act of 2013,'' would reduce, during the 4-year period
beginning on the date that is one year after the date of enactment, the
amount of wages paid the eligible Veteran or person in an OJT program
not later than the last full month of that training period from 85
percent to 75 percent of the wages paid for the job for which such
individual is being trained
Section 3 of the draft bill would require VA, beginning 1 year
after the date of enactment, to enter into agreements with other
Federal departments and agencies to operate their own OJT programs
under section 3677 of title 38, United States Code, to train eligible
Veterans or persons in skills necessary to obtain employment by those
entities. Finally, section 4 of the draft bill would extend from
November 30, 2016, until December 31, 2016, the requirement in 38
U.S.C. Sec. 5503(d) to reduce pension payments for certain
beneficiaries who receive services from a nursing facility under a
Medicaid plan.
VA does not object to the provision in section 2 that would
temporarily reduce the wage requirement from 85 percent to 75 percent,
subject to Congress identifying appropriate offsets for the increased
benefit costs that would result from the increased participation in the
OJT program. VA anticipates that this amendment may increase employer
and Veteran participation in OJT programs, increasing the number of
job-training programs for Veterans in the future. However, VA cannot
determine how much OJT participation would increase until more data
become available after the implementation of this program. VA supports
the intent underlying section 3; however, we do not believe legislation
is necessary because VA currently has the authority to approve Federal
OJT and apprenticeship programs under section 3672(b) of title 38,
United States Code. Furthermore, the bill is unclear as to: (1) the
purpose of such agreements beyond VA approval (For instance, it could
be to document exchange of funds, specify program content, or require
or commit such departments/agencies to carry out such training); and
(2) what entity would provide the training (VA or the other Federal
department/agency).
VA will provide views and a cost estimate for section 4 of the bill
for the record at a later date.
s. 1262--veterans conservation corps act of 2013
Section 2(a) of S. 1262 would require the Secretary of Veterans
Affairs, in cooperation with the Attorney General, the Secretary of
Agriculture, the Secretary of Commerce, the Secretary of Homeland
Security, the Secretary of the Interior, and the Chief of Engineers, to
establish a Veterans conservation corps to assist Veterans in the
transition from service in the Armed Forces to civilian life and to
employ Veterans in conservation, resource management, and historic
preservation projects on public lands and maintenance and improvement
projects for cemeteries under the jurisdiction of the National Cemetery
Administration; and as firefighters, law enforcement officers, and
disaster relief personnel. This bill would establish a priority for
Conservation Corps hiring for Veterans who served after September 11,
2001.
Section 2(b) of the bill would require as part of the Veterans
conservation corps that the Secretaries of Veterans Affairs,
Agriculture, Commerce, and the Interior and the Chief of Engineers
employ Veterans; or award grants to, or enter into contracts with State
governments, local governments, or nongovernmental entities, to employ
Veterans to carry out the projects described in section 2(a) of the
bill.
Section 2(c)(1) of the bill would require as part of the Veterans
conservation corps that the Secretary of Homeland Security award grants
under section 34 of the Federal Fire Prevention and Control Act of 1974
to hire Veterans as firefighters. Section 2(c)(2) of the bill would
require the Attorney General to award grants under part Q of title I of
the Omnibus Crime Control and Safe Streets Act of 1968 to hire Veterans
as law enforcement officers. Section 2(c)(3) would require the
Secretary of Homeland Security to provide funds to increase
participation by Veterans in the Federal Emergency Management Corps
program.
Section 2(d) of the bill would authorize the Secretary of Veterans
Affairs to provide assistance to the officials listed in section 2(a)
of the bill to carry out the Veterans conversation corps. Such
assistance could take the form of transfers from amounts appropriated
or otherwise made available to the Secretary of Veterans Affairs to
carry out the Veterans conservation corps. Section 2(d)(3) of the bill
would require the Secretary of Veterans Affairs to establish a steering
committee consisting of the Secretaries of Veterans Affairs,
Agriculture, Commerce, and the Interior and the Chief of Engineers to
establish selection criteria and provide advice in connection with
award of assistance as authorized under section 2(d) the bill.
Section 2(e) of the bill would require the Secretary of Veterans
Affairs to establish a reporting framework to ensure proper oversight
and accountability of the Veterans conservation corps. Section 2(f) of
the bill would require the Secretary of Veterans Affairs to ensure that
Veterans employed under the Veterans conservation corps are aware of
benefits and assistance available to them under the laws administered
by VA. Finally, Section 2(g) would authorize appropriations to the
Secretary of Veterans Affairs to carry out the bill in the amount of
$600,000,000 for the period of FY 2014 through FY 2018.
S. 1262 includes similar concepts to the Administration's Veterans
Job Corps proposal presented in its Fiscal Year 2014 budget. VA would
welcome the opportunity to work with the Committee on this bill.
s. 1281--veterans and servicemembers employment rights and
housing act of 2013
S. 1281, the ``Veterans and Servicemembers Employment Rights and
Housing Act of 2013,'' would prohibit discrimination in employment and
housing on the basis of military service. Section 2 of S. 1281, which
would prohibit employment-related discrimination on the basis of
military service, would affect programs or laws administered by the
Equal Employment Opportunity Commission (EEOC) and Office of Personnel
Management (OPM). In addition, section 2(g), which addresses employment
practices related to national security, would affect matters under the
jurisdiction of Department of Homeland Security (DHS). Section 3, which
would prohibit residential housing-related discrimination on the basis
of military service, would affect programs or laws administered by the
Department of Housing and Urban Development (HUD). In addition, both
sections 2 and 3 of the bill relate to matters of Department of Justice
(DOJ) enforcement. Further, because S. 1281 addresses current as well
as former members of the uniformed services, the bill would involve
matters related to Department of Defense (DOD). Accordingly, we defer
to those departments' views on this bill. We understand that DOJ
appreciates the goals of the bill, but may suggest alternative
approaches more consistent with current enforcement schemes.
s. 1295--regarding notice to veterans filing electronic claims for
benefits of the availability of services from veteran services
organizations
S. 1295 would add to title 38, United States Code, a new section
5103B, which would require, ``[t]o the degree practicable,'' VA to
notify claimants, when they electronically file applications for VA
benefits, that relevant services may be available from VSOs. S. 1295
would also require VA to provide claimants a list of VSOs and
applicable contact information.
VA appreciates the intent of S. 1295, but does not support the bill
because VA has been able to carry out its purpose under current law. VA
already notifies claimants who file claims electronically that VSO
representation is available. In addition, VA already provides claimants
easy access to information about claim representation from VA-
accredited VSO representatives, claims agents, and attorneys. For
example, the electronic benefits Web site (http://www.ebenefits.va.gov/
) provides a link to a directory of all VA-recognized VSOs with their
contact information. This directory is searchable and allows a claimant
to search for VA-accredited VSO representatives, claims agents, and
attorneys by location. Although VA views the bill as unnecessary, VA
supports the intent of the bill and will continue to ensure that notice
of available representation is clearly indicated on its electronic
application portal, eBenefits.
VA estimates that there would be no benefit costs or GOE costs
associated with enactment of this bill.
s. 1361--world war ii merchant mariner service act
S. 1361, the ``World War II Merchant Mariner Service Act,'' would
direct the Secretary of DHS to accept certain types of evidence for
verifying that an individual performed honorable service as a coastwise
merchant seaman during the period beginning on December 7, 1941, and
ending on December 31, 1946, for purposes of eligibility for certain
Veterans' benefits. Although service as a merchant seaman does not
generally constitute active duty service conferring eligibility for
Veterans' benefits, the GI Bill Improvement Act of 1977 authorized DOD
to designate the service of certain groups as active duty service
sufficient to confer eligibility for Veterans' benefits. Pursuant to
that authority, DOD has determined that the service of the ``American
Merchant Marine in Oceangoing Service during the Period of Armed
Conflict, December 7, 1941, to August 15, 1945,'' shall constitute
active duty for purposes of eligibility for Veterans' benefits.
DHS is responsible for verifying that an individual served in the
American Merchant Marine in oceangoing service during the specified
period. A finding in section 2 of S. 1361 identifies the types of
documentation DHS currently accepts to establish such qualifying
merchant-seaman service. Section 3 of S. 1361 would direct DHS to
accept certain alternative types of evidence as sufficient to establish
qualifying merchant-seaman service for purposes of certain Veterans'
benefits and other purposes. In the absence of a Coast Guard shipping
or discharge form, ship logbook, merchant mariner's document or Z-card,
or other official employment record, the alternative sources of
evidence would include Social Security Administration records together
with validated testimony and other official documentation. Under
section 3(c) of the bill, a finding of qualifying active duty service
based on such alternative forms of evidence would establish eligibility
for burial benefits under chapters 23 and 24 of title 38, United States
Code, but would not establish eligibility for other Veterans' benefits.
Section 3(c) would further provide that a person found to have
qualifying service pursuant to this bill would be eligible for
applicable medals, ribbons, and military decorations and would be
``honored as a veteran,'' but would not be entitled to Veterans'
benefits other than those specified in the bill.
VA supports measures to ensure that individuals who have qualifying
service can establish eligibility for the benefits they have earned.
However, because DHS, rather than VA, is responsible for the service
verifications to which this bill pertains, VA defers to the views of
DHS regarding section 3 of this bill.
VA's National Cemetery Administration (NCA) has not encountered
significant difficulties in obtaining verification of qualifying
oceangoing service in the merchant marine. NCA reviewed the number of
cases in its Burial Operations Support System from September 25, 2012,
through June 10, 2013, that listed Merchant Marine as the Branch of
Service. NCA approved 168 requests for burial, while only three
requests were denied because qualifying oceangoing service during World
War II was not established.
VA cannot determine whether this bill would lead to any increase in
the provision of burial benefits to merchant mariners and their
survivors. Therefore, VA cannot provide a cost estimate.
s. 1399--amending the servicemembers civil relief act
S. 1399 would extend the interest rate limitation on debts incurred
before military service to debts incurred during military service to
consolidate or refinance student loans incurred before military
service. This bill would affect issues relating to current members of
the uniformed services and consequently is of primary concern to DOD.
The bill further relates to matters of the Department of Education, the
Consumer Financial Protection Bureau and DOJ enforcement. Accordingly,
we defer to those agencies' views on this bill.
s. 1411--rural veterans health care improvement act of 2013
S. 1411, Rural Veterans Health Care Improvement Act of 2013 (the
``Act''), would direct the Department to apply specified consultation,
information, and transmittal requirements when issuing VHA's planned
update of the 2010-2014 Strategic Plan of the VHA Office of Rural
Health (ORH). Specifically, the bill would require the ORH update or
successor plan to be prepared in consultation with the Director of
VHA's Office of Health Care Retention and Recruitment, the Director of
Quality and Performance, and the Director of Care Coordination
Services. It would also have to include the following information
(relevant to the reporting period):
Goals and objectives for the recruitment and retention of
health care personnel in rural areas;
Goals and objectives for ensuring timeliness and improving
quality in the delivery of health care services in rural areas through
contract and fee-basis providers;
Goals and objectives for the implementation, expansion,
and enhanced use of telemedicine services in rural areas, including
through coordination with other appropriate offices of the Department;
Goals and objectives for ensuring the full and effective
use of mobile outpatient clinics for the provision of health care
services in rural areas, including goals and objectives for the use of
such clinics on a fully mobile basis and for encouraging health care
providers who provide services through such clinics to do so in rural
areas;
Procedures for soliciting from each VA facility that
serves a rural area the following information: the clinical capacity of
facility; the procedures of such facility in the event of a medical,
surgical, or mental health emergency outside the scope of the clinical
capacity of such facility; the procedures and mechanisms of such
facility for the provision and coordination of health care for women
veterans, including procedures and mechanisms for coordination with
local hospitals and health care facilities, the oversight of primary
care and fee-basis care, and the management of specialty care;
Goals and objectives for the modification of the funding
allocation mechanisms of the ORH to ensure that the Office distributes
funds to components of the Department to best achieve the goals and
objectives of the Office and in a timely manner;
Goals and objectives for the coordination of, and sharing
of resources with respect to, the provision of health care services to
veterans in rural areas between the VA, DOD, the Indian Health Service
of the Department of Health and Human Services (HHS), and other Federal
agencies, as appropriate and prudent;
Specific milestones for the achievement of the goals and
objectives developed for the update; and
Procedures for ensuring the effective implementation of
the update.
Finally, S. 1411 would require the Secretary to transmit the first
update (or successor plan) to Congress not later than 90 days after its
issuance, along with comments and recommendations deemed appropriate.
VA believes the bill is duplicative of both past and continuing
Departmental efforts and thus does not support S. 1411. Specifically,
ORH produced a 5-year strategic plan for FY 2010-2014 to ensure that
ORH programs and initiatives meet the health care needs of rural
Veterans. That plan was refreshed in FY 2011 to better align ORH
resources with identified health care needs, especially in light of new
technologies and delivery systems for rural Veterans.
Further, ORH is currently developing a new strategic plan for FY
2015-2019 to better align our goals with those outlined in the FY 2013-
2018 VHA strategic plan to better serve the future health care needs of
rural Veterans given the changing landscape of health care delivery and
access and the stronger emphasis on prevention and community wellness.
Goals of the FY 2015-2019 ORH strategic plan include strategic
dissemination and integration within and outside VA of best practices
in rural health care delivery to increase access and quality;
strengthening of the rural health infrastructure through partnerships
and collaborations with other Federal and community entities; enhancing
rural provider capacity through increased student clinical training
opportunities in rural areas and increased rural provider training
opportunities; and enhancing rural telehealth capabilities. ORH will
also continue to evaluate its on-going programs, including the pilot
and demonstration projects that ORH currently funds across the VA
health care system, in order to assess their effectiveness in
delivering quality care to rural Veterans and improving those
individuals' access to care.
The FY 2015-2019 ORH strategic plan will be re-evaluated annually
to determine if additional initiatives or actions are needed. During FY
2019, ORH will draft a new strategic plan based on its evaluation of
the success of past projects undertaken to date and updated assessments
of the health care needs of Veterans residing in rural areas.
s. 1434--to designate the junction city community-based outpatient
clinic as the lieutenant general richard j. seitz community-based
outpatient clinic
S. 1434 would designate the Junction City Community-Based
Outpatient Clinic located at 715 Southwind Drive, Junction City,
Kansas, as the ``Lieutenant General Richard J. Seitz Community-Based
Outpatient Clinic.'' VA defers to Congress in the naming of this
facility.
s. 1471--alicia dawn koehl respect for national cemeteries act
Section 2 of S. 1471, the ``Alicia Dawn Koehl Respect for National
Cemeteries Act,'' would authorize the Secretary of Veterans Affairs and
the Secretary of the Army to reconsider a decision to inter the remains
or honor the memory of a person in a NCA national cemetery or in
Arlington National Cemetery, respectively, when the appropriate Federal
official receives information that the person may have committed a
Federal capital crime or State capital crime but had not been convicted
of such crime by reason of such person not being available for trial
due to death or flight to avoid prosecution.
If the appropriate Federal official finds, based on a showing of
clear and convincing evidence and after an opportunity for a hearing in
a manner prescribed by the appropriate Federal official, that the
person committed a Federal capital crime or a State capital crime but
was not convicted of such crime by reason of not being available for
trial due to death or flight to avoid prosecution, section 2 would
require the official to notify appropriate survivors and provide an
opportunity to appeal the decision to disinter the remains or remove
the memorial headstone or marker.
Regarding VA, when a decision to disinter remains or remove a
memorial headstone or marker becomes final by either failure to appeal
the decision or by a decision of the Board of Veterans' Appeals (BVA or
Board) upholding the decision, VA would have the authority to: (1)
disinter the person's remains from a VA national cemetery and provide
for reburial or other appropriate disposition of the disinterred
remains in a place other than in a VA national cemetery or in Arlington
National Cemetery; and (2) remove a Government-furnished memorial
headstone or marker. The authority for reconsideration would apply to
any interment or memorialization conducted by the Secretary of Veterans
Affairs or the Secretary of the Army in a VA national cemetery or in
Arlington National Cemetery after the date of enactment of the Act. VA
supports section 2 of this legislation.
Section 3 of the bill would require the Secretary of Veterans
Affairs to disinter the remains of Michael LaShawn Anderson from Fort
Custer National Cemetery. VA would be required to notify Mr. Anderson's
next-of-kin of record of the impending disinterment of his remains and
upon disinterment relinquish his remains to the next-of-kin of record
or arrange for an appropriate disposition of the remains if the next-
of-kin of record is unavailable.
Section 2 of S. 1471 would not authorize VA to reconsider a
decision if an individual was convicted of a Federal or State capital
crime or convicted of a Tier III sex-offense and VA had not received
prior written notice of the conviction. VA would support closing this
gap and will be glad to work with the Committee to provide technical
assistance to effect broadening the scope of the legislation. Regarding
the portions of section 2 which apply to the Department of the Army, we
defer to that Department's views on this bill.
VA has another technical concern regarding the bill language in
proposed section 2411(d)(4)(B) that states, ``A notice of disagreement
filed with the Secretary under subparagraph (A) shall be treated as a
notice of disagreement filed with BVA under chapter 71 of this title,
and shall be decided by the BVA in accordance with the provisions of
that chapter.'' The language is problematic because notices of
disagreement are not filed ``with the Board'' under chapter 71. Under
section 7105(b)(1) of title 38, United States Code, notices of
disagreement are filed ``with the activity that entered the
determination with which disagreement is expressed.'' Thus, the
language ``with the Board of Veterans' Appeals under chapter 71''
should be changed to ``under section 7105.''
VA will provide a cost estimate for S. 1471 for the record at a
later date.
s. 1547--veterans dialysis pilot program review act of 2013
If enacted, S. 1547 would prohibit VA from expanding VA's dialysis
pilot program to facilities other than the four participating
outpatient facilities until after VA has implemented the pilot program
at each facility for at least 2 years, VA has provided for an
independent analysis of the pilot program at each facility, and a
report to Congress has been submitted. The report must address any
recommendations from the Government Accountability Office (GAO) with
respect to the pilot.
This bill would have the effect of prohibiting VA from activating
any additional free-standing dialysis centers until at least July 2015
because one of the pilot facilities (in Cleveland, Ohio) was not
activated until July 2013. VA supports using the results from the
dialysis pilot to help inform future decisions on delivering care. VA
would be glad to work with the Committee to ensure the Committee is
briefed on the results of the pilot program before establishing any new
free-standing dialysis clinics. VA is concerned that enactment of this
bill in its current form would delay activating additional VA free-
standing dialysis centers that could adversely impact VA's efforts to
optimize Veterans' dialysis care.
An independent review of two of the pilot facilities (Raleigh and
Fayetteville, North Carolina) has already been conducted by the
University of Michigan Kidney Epidemiology and Cost Center, and VA has
responded to, and concurred in, the five recommendations identified in
the GAO report on the VA Dialysis Pilot issued in May 2012.
s. 1558--a bill to require the secretary of veterans affairs to carry
out a program of outreach for veterans
S. 1558, the ``Veterans Outreach Enhancement Act of 2013,'' would
require VA to establish a five-year program for the purpose of
increasing Veterans' use of the range of Federal, State, and local
programs that provide compensation or other benefits, as well as
increasing Veterans' awareness of such programs and their eligibility.
VA would have authority to enter into agreements with Federal and State
agencies to further the purposes of the program. VA also would have
authority to enter into agreements with certain named regional
authorities and commissions to provide technical assistance, award
grants, enter into contracts, or otherwise provide amounts to persons
or entities for projects that accomplish specifically enumerated
purposes. The bill also would require within 4 years a comprehensive
report to Congress on VA's outreach activities.
VA appreciates and shares the Committee's interest in expanding
outreach activities through collaborative agreements and partnerships
and is very supportive of the concept and purpose of this legislation.
As detailed below, VA currently has a number of agreements and programs
with similar aims as this bill.Unless Congress provides additional
funds to support S. 1558, however, entering into the grants and
contracts envisioned by the bill would require offsets from funding for
existing programs. We therefore are concerned about the impact on the
legislation on existing VA outreach programs.
Section 2(d)(1) of S. 1558 would allow VA to ``enter into
agreements with other Federal and State agencies to carry out projects
under the jurisdiction of such agencies to further the purpose'' of the
bill. VA is continually seeking to improve our collaboration and
coordination with State, local, and tribal agencies to increase
awareness and access to VA benefits and services. VA has existing
agreements regarding outreach to Veterans with DOD, DOL, the National
Association of State Directors of Veterans Affairs, and the National
Association of County Veterans Service Officers, to name a few. We
believe VA already has the authority to carry out the purpose of
section 2(d)(1).
Section 2(d)(2) of the bill would provide VA authority to ``enter
into agreements with'' specifically enumerated ``applicable authorities
and commissions'' in order ``to provide technical assistance, award
grants, enter into contracts, or otherwise provide amounts to persons
or entities for projects and activities that'' pursue specifically
enumerated goals. VA certainly encourages expanded authority to further
the goals of the bill. However, the language in section 2(d)(2) is
ambiguous with regard to the nature and scope of the authority, and how
such authority differs from the authority provided for under section
2(d)(1), apart from the entities to which each section refers. We are
concerned that the authorizing language may not be specific enough to
provide sufficient guidance for the creation of a grant program.
Moreover, section 2(d)(2)(D) is focused on education and outreach
related to the Uniformed Services Employment and Reemployment Rights
Act (USERRA), a law that falls under the jurisdiction of the Department
of Labor (DOL). VA believes that any such education and outreach on
USERRA should be coordinated through a Memorandum of Understanding with
DOL.
Section 2(d)(3) specifically enumerates the ``applicable
authorities and commissions'' discussed in section 2(d)(2). VA believes
the funding authority should also encompass local and tribal
governments. Many local and tribal governments have established
Veterans agencies with which VA currently partners to conduct outreach.
The ability to provide direct assistance to those governments could be
a more efficient use of funds in some situations.
Section 2(e) would provide VA the authority to provide, or contract
with public and private organizations to provide, information, advice,
and technical assistance to nonprofit organizations. VA supports the
authority provided in this subsection, but recommends expanding this
authority to provide technical assistance to other entities as well.
Circumstances vary by jurisdiction. We believe States may be in a
better position in some instances to meet the goals of this section.
Expanding the scope of this provision to encompass States would allow
VA a wider range of options.
With regard to the comprehensive report on the outreach activities
of VA that would be required under section 2(f), VA is already required
to provide a biennial report on all VA outreach activities under
section 402 of Public Law 109-233. All outreach activities associated
with this legislation would be included in the outreach reports to be
provided to Congress under Public Law 109-233. VA believes this
additional reporting requirement is unnecessary.
VA has a strong interest in ensuring that Veterans know of the
benefits they have earned--the role of outreach is critical throughout
the myriad missions of VHA, VBA, and NCA. We would be glad to meet with
the Committee to discuss ongoing outreach efforts and the ideas
represented in this bill. VA will provide its cost estimate for this
bill at a later time.
s.------ (draft bill) veterans health care eligibility expansion and
enhancement act of 2013
The draft bill would expand eligibility for VA health care. While
VA understands the intent behind expanding eligibility and enhancing
services for Veterans. However, before providing definitive views, VA
must carefully consider the implications of each provision of this
bill, including the cost for such expansion and the impact upon
existing eligible populations. VA received the text of this bill on
October 11, 2013 and is continuing this analysis. VA will provide a
more detailed response that will specifically address each provision--
including cost information--within a short time of this hearing.
Section 2 of the bill would amend 38 U.S.C. 1710(a)(3) by replacing
``may, to the extent resources and facilities are available,'' with
``shall.'' We are evaluating the impact of this proposed change,
particularly as it pertains to section 1705, which specifies how the
Secretary is to manage the system of patient enrollment.''
Section 3 of the bill would add a new subsection to 38 U.S.C. 1705
which would require the Secretary to provide for the enrollment of
certain veterans who are unable to enroll in the VA health care system
as of the date of the enactment of the bill and who do not have access
to health insurance except through a health exchange established
pursuant to section 1311 of the Affordable Care Act. Section 3 would
require VA to work with HHS and the Department of Treasury to access
information regarding the ``access to healthcare'' via the exchanges.
Section 3 of the bill presents many potential complications and
uncertain effects on VA's enrollment system, as well as issues that
will require detailed consultation with HHS and the Department of
Treasury. We will address issues concerning section 3 in a more
detailed response to the Committee.
Section 4 of the bill would expand the combat eligibility provision
in 38 U.S.C. 1710(e)(1)(D) for Veterans discharged after January 28,
2003, from 5 years from the date of the Veteran's discharge to 10
years. Section 4 would also extend eligibility for Veterans who were
discharged before January 28, 2003 until January 27, 2018. VA supports
the intent of section 4 of the bill but would be interested in further
discussion on other options to expand access to Combat Veterans.
Section 6 of the bill would require VA and the Secretary of Health
and Human Services to carry out the ``Medicare VA reimbursement
program'' wherein HHS would reimburse VA for certain health care
furnished to Medicare-eligible Veterans. Section 7 of the bill would
direct VA to make certain modifications for purposes of determining
whether veterans qualify for treatment as low income families for
enrollment under 38 U.S.C. 1705(a)(7). Section 8 of the bill would
require VA to use the capitation-based resource allocation model in
entering into contracts for the furnishing of health care services.
From our preliminary review to date, VA has particular concerns
with Sections 6, 7 and 8 of this bill, and needs additional time to
fully study the impact on existing business infrastructure, billing
systems, and net Federal costs. In regards to section 6, VA needs
additional time to fully understand the impact of obtaining Medicare
reimbursement, which will require consultation with HHS. VA expects
there will be costs to set up the infrastructure for billing Medicare,
as well as new benefit costs to the Medicare program. Section 7 is
technically feasible, but requires further investigation to ensure it
represents an equitable approach to expanding health care eligibility
for low-income Veterans. Section 8 would be challenging because it
would change the payment structure for non-VA medical care.
Mr. Chairman, as noted above, we are working diligently to provide
fuller analysis and notes on anticipated costs shortly after this
hearing. As you know, we have had the opportunity to discuss the
critical subject of access to health care for Veterans with you and
Committee staff prior to receiving the text of this bill. We look
forward to continuing those discussions.
s.------ (draft bill) regarding the service-disabled veterans insurance
program
The draft bill would update the Service-Disabled Veterans Insurance
(S-DVI) program by amending section 1922(a) of title 38, United States
Code, to base premium rates on the 2001 Commissioners Standard Ordinary
(CSO) Mortality Table instead of the 1941 CSO Mortality Table currently
used in that program.
VA supports the intent of this draft bill to change the mortality
basis of the S-DVI program, provided Congress finds corresponding
funding offsets. The S-DVI program was intended to enable service-
disabled Veterans to purchase insurance coverage at ``standard''
premium rates. Currently, S-DVI premiums are based on an old mortality
table, i.e., the 1941 CSO Mortality Table, with 2.25 percent interest.
In 1951, when this program began, these premium rates were competitive
with commercial insurance policy rates. However, because life
expectancy has significantly lengthened over the past 50 years, a more
recent mortality table would reflect lower mortality and, hence, lower
premium rates.
The draft bill would base S-DVI premiums on the 2001 CSO Mortality
Table, which is the current mortality standard in the commercial
insurance industry. This would result in significantly lower premium
costs for service-connected disabled Veterans. As a result, VA could
see a greater number of such Veterans applying for S-DVI coverage,
thereby enhancing financial security for them and their families.
Further, because this draft bill would also reduce premiums for current
policyholders, it would allow both new and current policyholders who
are paying premiums to use funds they currently expend on their S-DVI
premiums for other purposes. Approximately 60 percent of current
policyholders have their premiums waived because they have been
determined to be ``totally disabled.'' A comparison conducted by VA of
current premium rates with those that would be charged shows that
premiums would be dramatically reduced for some individuals, and all
policyholders would see their premiums significantly reduced.
VA recommends that the bill be amended to also change the interest
rate basis from 2.25 percent to 3 percent. Current economic indicators
suggest that 3 percent more accurately reflects a realistic long-term
interest rate for this program. Changing the basis to 3 percent would
further lower the premium rates for S-DVI policyholders.
VA will provide a cost estimate for the record at a later time.
______
Additional Views Submitted by the U.S. Department of Veterans Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
s. 1155--rural veterans mental health care improvement act
Section 3(a) would require VA, in carrying out the education and
training program required under section 7302(a)(1) of title 38, U.S.C.,
to include education and training of marriage and family therapists and
licensed professional mental health counselors. VA does not support
section 3(a).
VA cannot offer clinical education to Licensed Professional Mental
Health Counselors (LPMHC) and Marriage and Family Therapist (MFT)
trainees until the following VA requirements are met:
1. Accreditation. The trainee's educational program must be
accredited by a National Accrediting Body formally recognized by the
U.S. Department of Education or the Council for Higher Education
Accreditation.
2. Affiliation Agreement. The VA facility must have a formal
Affiliation Agreement with the Educational Institution or Training
Program.
3. Supervisory Staff. The VA training program must have sufficient
qualified and experienced supervisory staff licensed or otherwise
authorized to practice in VA in the same profession as the trainees.
4. Ability to Hire Graduates. There must be national program office
agreement that the trainees in the training program would gain
credentials to be hired into VA according to current qualification
standards for the discipline.
5. Administrative Infrastructure. There must be sufficient
administrative infrastructure, including staff support, space, and
information technology equipment.
6. Patient Population. There must be a sufficient and appropriate
patient population to meet curricular goals for the training program.
Within several years, it is likely that VA will include the
education and training of LPMHCs and MFTs in the health professions
trainee program conducted under the authority in section 7302, thereby
satisfying the intent of section (a). However, VA is not currently
positioned to address many of the requirements enumerated above. For
example, VA does not yet have an affiliated training partner, adequate
supervisory staff or administrative infrastructure to support such a
program.
Section 3(b) would require VA to apportion funding for the
education and training program equally among the professions included
in the program. The text in section 3(b) is of serious concern to VA,
and thus we do not support the provision. The creation of a VA-paid
stipend program for LPMHC and MFT master's degree students is a
different process from local development of an affiliation agreement to
offer clinical training to ``without compensation trainees.''
Individual medical centers do not have authority to offer stipends for
clinical training. All stipends for clinical trainees are authorized at
the national level and paid for by centralized funds. The decision to
offer stipends to a particular discipline is made at the national level
by program offices after consultation with national leadership
governance bodies.
Once stipends are authorized nationally, trainee positions are then
competitively offered to VA facilities that wish to participate. The
decision to authorize stipends for trainees is based on several
criteria, including the following: (1) whether VA is having difficulty
recruiting professionals in the discipline in question; (2) whether
funding is available for these new trainee stipends or can the funding
be redirected from other already established training programs; and (3)
the standards in the health care community regarding stipends for
trainees of the discipline. Veterans Health Administration (VHA) Office
of Academic Affiliations works closely with VHA's Workforce Talent
Management Office to track recruitment demand that might warrant a
funded training program.
VHA must retain funding flexibility across all health professions
trainee programs. A bill requiring ``equal funding across professions''
would significantly diminish VHA's ability to implement changes to the
health professions trainee programs based on emerging Veteran needs.
Cost estimates cannot be provided for section 3. There is no cost
for allowing Without Compensation (WOC) trainees to rotate through VA
as long as the criteria for training programs are met (see above).
However, in this instance, where the criteria for training LPMHCs and
MFTs are not yet met, funding for training LPMHCs and MFTs would be
considerably distant and therefore not easily determined at this time.
VHA would need extensive experience with the WOC trainees before a
request for authorization of stipends could be properly evaluated and
approved.
We believe that section 4 of S. 1155 contains a drafting error, and
that it is intended to amend section 304 of Public Law (P.L.) 111-163,
as amended by section 730 of Public Law 112-239, which added a new
subsection (e) to section 304. If this understanding is correct, VA
believes the net effect of amendments would be as follows. Peer
outreach and peer support services would continue to be provided to the
Veterans specified in section 304 pursuant to subsections 304(a)(1)(A)
and (B). Under new subsection (e)(2), VA would be required to carry out
the services in subsection (a)(2) of section 304 at or through VA
medical centers.
It is not clear whether adding subsection (e)(2) to section 304 is
intended to clarify or change the provision of mental health services
to the immediate family members of these Veterans. We note that the
language, ``at or through Department medical centers'' would authorize
VHA to provide those mental health services described in subsection
(a)(2) at VA medical centers, community based outpatient clinics
(CBOCs) or by use of contracts. We would welcome the opportunity to
discuss this provision with the Committee.
Because the impact of this section is unclear, we cannot provide a
cost estimate at this time.
Section 5 of S. 1155 would require the Secretary to submit a report
to Congress not later than 120 days after the date of enactment of the
Act that addresses the following:
Issues that may be impeding the provision of telemedicine
services for Veterans, including the following:
- Statutory or regulatory restrictions
- Licensure or credentialing issues for any provider
practicing telemedicine with veterans who live in a different
State than the provider
- Limited broadband access in rural areas
- Limited information technology resources or capabilities
- Long distances veterans must travel to access a facility or
clinic with telemedicine capabilities
- Insufficient liability protection for providers
- Reimbursement issues faced by providers
- Travel limitations for providers that are unaffiliated with
VA and are participating or seeking to participate in a VA
telemedicine program
Actions taken to address the issues identified above
An update on efforts to carry out the initiative of
teleconsultation for the provision of remote mental health and
Traumatic Brain Injury assessments required by 38 U.S.C. 1709A
An update on efforts to offer training opportunities in
telemedicine to medical residents, as required by section 108(b) of
Public Law 112-154, codified at 38 U.S.C. 7406, note
An update on efforts, in partnership with primary care
providers, to install video cameras and instruments to monitor weight,
blood pressure, and other vital statistics in the homes of patients.
Section 5 would also define ``telemedicine'' as the use by a health
care provider of telecommunications to assist in the diagnosis or
treatment of a patient's medical condition.
VA has no objection to reporting on the content specified in
sections 5(a)(1)(E) (the distances a Veteran must travel to access a
telemedicine-equipped facility), 5(a)(3) (certain teleconsultation
initiatives) and 5(a)(4) (residents telemedicine training) of this
bill. The provisions are straightforward.
VA does not support reporting on the content specified in section
5(a)(1)(A) (statutory and regulatory restrictions) because it is
unnecessary and duplicative of recent efforts. VA and Department of
Defense (DOD) already collaborate and share information about the
provision of telehealth services to Veterans and Servicemembers. VA
does not support providing a report related to the content specified in
sections 5(a)(1)(B) (licensure and credentialing and privileging
issues), 5(a)(1)(F) (insufficient liability protection issues),
5(a)(1)(G) (provider reimbursement issues) and 5(a)(1)(H) (travel
limitations for providers). VA does not believe these issues impact or
impede VA providers or VA's ability to provide telehealth services and
so these are not areas we believe appropriate for a reporting
requirement. VA would welcome discussion with the Committee if there
are differing perceptions regarding those issues.
VA seeks clarification on what is meant by ``limited'' broadband
access in rural areas and ``limited'' information technology resources
or capabilities in sections 5(a)(1)(C) and (D).
VA does not anticipate that section 5 would result in any
additional costs.
s. 1165--access to appropriate immunizations for veterans act of 2013
S. 1165 would amend section 1701 of title 38, U.S.C., to include
certain adult immunizations as part of the preventive services detailed
in subsection 9 of the statute. The bill would also amend section 1706
of title 38, U.S.C., to require VA to develop quality measures and
metrics to ensure that Veterans receiving medical services also receive
the immunizations. As discussed in VA's October 30, 2013 testimony, VA
strongly supports preventive care measures, but does not support this
legislation because VA is already satisfying the intent of this bill.
VA estimates the costs associated with enactment of developing and
implementing quality measures in S. 1165 to be as follows: $639,188 in
FY 2014; $3.24 million over 5 years; and $6.6 million over 10 years.
s. 1411--rural veterans health care improvement act of 2013
S. 1411, Rural Veterans Health Care Improvement Act of 2013 (the
``Act''), would direct the Department to apply specified consultation,
information, and transmittal requirements when issuing VHA's planned
update of the FY 2010-2014 Strategic Plan of the VHA Office of Rural
Health (ORH). For the reasons stated in VA's October 30, 2013
testimony, VA does not support S. 1411.
VA estimates the costs associated with enactment of S. 1411 to be
as follows: $323,808 for FY 2013; $930,842 over a 5 year period; and
$1,943,545 over a 10 year period.
s. 1471--alicia dawn koehl respect for national cemeteries act
Section 2 of S. 1471 would authorize the Secretary of Veterans
Affairs and the Secretary of the Army to reconsider a decision to inter
the remains or honor the memory of a person in a cemetery in the
National Cemetery Administration or in Arlington National Cemetery,
respectively, when the appropriate Federal official receives
information that the person may have committed a Federal capital crime
or State capital crime but had not been convicted of such crime by
reason of such person not being available for trial due to death or
flight to avoid prosecution.
If the appropriate Federal official finds, based on a showing of
clear and convincing evidence and after an opportunity for a hearing in
a manner prescribed by the appropriate Federal official, that the
person committed a Federal capital crime or a State capital crime but
was not convicted of such crime by reason of not being available for
trial due to death or flight to avoid prosecution, section 2 would
require the official to notify appropriate survivors and provide an
opportunity to appeal the decision to disinter the remains or remove
the memorial headstone or marker.
Section 3 of the bill would require the Secretary of Veterans
Affairs to disinter the remains of Michael LaShawn Anderson from Fort
Custer National Cemetery. VA would be required to notify Mr. Anderson's
next-of-kin of record of the impending disinterment of his remains and
upon disinterment relinquish his remains to the next-of-kin of record
or arrange for an appropriate disposition of the remains if the next-
of-kin of record is unavailable. VA provided views for this bill at the
October 30, 2013, hearing.
VA estimates that there would be no significant costs or savings
associated with enactment of section 2 of S. 1471 because situations
where the authority provided by this bill would be needed would be
uncommon and VA does not anticipate a significant increase in such
cases.
s. 1558--veterans outreach enhancement act of 2013
S. 1558 would require VA to establish a 5 year program for the
purpose of increasing Veterans' use of the range of Federal, State, and
local programs that provide compensation or other benefits, as well as
increasing Veterans' awareness of such programs and their eligibility.
VA would have authority to enter into agreements with Federal and State
agencies to further the purposes of the program. VA also would have
authority to enter into agreements with certain named regional
authorities and commissions to provide technical assistance, award
grants, enter into contracts, or otherwise provide amounts to persons
or entities for projects that accomplish specifically enumerated
purposes. The bill also would require within four years a comprehensive
report to Congress on VA's outreach activities.
VA is unable to estimate the costs that would be associated with
enactment of this bill at this time. S. 1558 would authorize $7 million
for FY 2014 and $35 million for FY 2015 through FY 2019 to carry out
the program that this bill would authorize. The actual costs would
depend on the extent that VA utilizes the authorities established in
the bill to carry out the required outreach program.
s. 1559--benefits fairness for filipino veterans act of 2013
S. 1559 would amend section 107(c) of title 38, U.S.C., to prohibit
the Secretary of Veterans Affairs from determining that a World War II
Filipino Veteran is not an individual residing in the United States for
purposes of that subsection solely because the person is outside the
United States for any period of time less than one year. Under this
bill, certain Filipino Veterans would be considered residents of the
United States when they are outside of the United States for any period
of time less than one year and therefore would be eligible for full-
dollar rate of benefits under section 107(a) or (b).
Section 107 authorizes certain Veterans benefits for World War II
Filipino Veterans with qualifying service and their survivors. These
benefits are paid at half of the full rate of payment, except for
individuals ``residing in the United States'' who are also either a
U.S. citizen or an alien lawfully admitted for permanent residence in
the United States. Section 1734 of title 38, U.S.C., requires the same
residency and citizenship or alien status for otherwise eligible World
War II Filipino Veterans to be eligible for hospital and nursing home
care and medical services in the United States.
VA does not support S. 1559 because VA has already promulgated
regulations that utilize objective and reasonable criteria for
determining whether an individual meets the requirement of ``residing
in the United States'' for purposes of receiving benefits at the full-
dollar rate for World War II Filipino Veterans and their survivors.
Under existing VA regulations at 38 CFR 3.42(d)(1), ``to continue
receiving benefits at the full-dollar rate * * *, a veteran or a
veteran's survivor must be physically present in the [United States]
for at least 183 days of each calendar year in which he or she receives
payments at the full-dollar rate, and may not be absent from the
[United States] for more than 60 consecutive days at a time unless good
cause is shown.''
When VA promulgated these regulations, VA explained that ``Congress
did not intend to create a windfall for Filipino Veterans who do not
actually face the higher cost of living in the [United States]'' and
that, ``[i]n order to avoid that potential result, Congress required
that Filipino Veterans be residing in the [United States] and either be
citizens of the [United States] or aliens lawfully admitted for
permanent residence in the [United States].'' Filipino Veterans'
Benefits Improvements, 66 Fed. Reg. 66,763 (Dec. 27, 2001). VA reasoned
that ''[i]f a veteran is absent from the [United States] for longer
than these periods, it is reasonable to conclude that he or she is not
residing in the [United States] * * *. This rule will also allow
veterans reasonable periods to travel outside of the [United States]
for business or personal reasons without having their benefits
reduced.'' Id. VA reasonably tailored its regulations to ensure that
full-dollar-rate benefits are paid to those Filipino Veterans who
maintain U.S. residency and face the higher costs of living in the
United States. Further, the regulations allow resumption of payments at
the full-dollar rate upon restored eligibility. This approach provides
flexibility for beneficiaries and is consistent with the adjustments
made to compensation awards based on other changes in beneficiary
status. Because S. 1559 would likely result in payment of full-dollar-
rate benefits to persons who do not reside in the United States, VA
does not support this bill.
s. 1573--military family relief act
Section 2(a) and (b) of S. 1573 would amend sections 1318 and 1541
of title 38, U.S.C., to establish in VA's dependency and indemnity
compensation (DIC) and pension programs a temporary 6 month benefit,
which VA would pay to an individual determined by the Secretary based
on evidence in a qualified deceased Veteran's file on the date of his
or her death to be the deceased Veteran's surviving spouse, without
that individual having to submit a claim for such benefits. For the
temporary DIC award, the Veteran would have to have been, at the time
of death, in receipt of or entitled to receive (or but for the receipt
of retired or retirement pay entitled to receive) compensation for a
service-connected disability continuously rated totally disabling for
not less than one year immediately preceding death. For the temporary
pension award, the Veteran would have to have been, at the time of
death, in receipt of pension under section 1513 or 1521 of title 38,
U.S.C., as a married Veteran based on the Veteran's marriage to the
individual. Section 2(c) would make a conforming amendment to section
5101(a)(1) of title 38, U.S.C., to reference possible exceptions, as
may be provided in title 38, U.S.C., to the present requirement for a
``specific claim in the form prescribed by the Secretary'' as a
prerequisite to benefit entitlement.
VA supports S. 1573, provided Congress finds corresponding funding
offsets. By authorizing VA to pay for 6 months following the Veteran's
death DIC or pension to the Veteran's surviving spouse based on the
Veteran's pre-existing disability ratings and dependent information in
VA systems on the date of the Veteran's death, and by expressly
eliminating the claim requirement, the bill would enable VA to automate
payments and quickly pay the surviving spouse during a difficult period
of transition and while VA is processing any other benefit claims that
the surviving spouse may have filed. These temporary awards would be
for transitional purposes only. Surviving spouses would still have to
apply for DIC or survivors' pension to continue benefit payments beyond
the six-month period prescribed in the bill.
VA estimates the benefit costs of enactment of S. 1573 would be
$58.2 million in FY 2015, $332.6 million over 5 years, and $759.8
million over 10 years. VA estimates no additional general operating
expenses associated with enactment of this bill because the bill would
permit automated payments based on data within VA systems. Therefore,
no additional claim development resources would be required.
s. 1576--to redesignate the department of veterans affairs healthcare
system located at 10000 bay pines boulevard as the ``c.w. bill young
department of veterans affairs medical center''
S. 1576 would re-designate the Department of Veterans Affairs
Healthcare System located at 10000 Bay Pines Boulevard as the ``C.W.
Bill Young Department of Veterans Affairs Medical Center.'' VA defers
to Congress on the naming of this facility.
s. 1578--medical foster home act of 2013
S. 1578 would authorize VA, in conducting the medical foster home
program pursuant to 38 CFR 17.73, to cover the costs of care of
Veterans in a VA-approved Medical Foster Home. Section 17.73 defines
``medical foster home'' to mean a private home in which a medical
foster home caregiver provides care to a Veteran resident, the
caregiver lives in the home and owns or rents the home, and there are
not more than three residents receiving care. These homes must meet VA
standards set forth in 38 CFR 17.74. To be eligible for the program,
the Veteran must be unable to live independently safely or be in need
of nursing home level care and agree to receive care in certain VA
programs designed to assist medically complex Veterans living at home.
VA supports enactment of this bill, particularly given the cost savings
as compared to paying for nursing home care.
If this bill is enacted, VA estimates cost savings will result as
follows: $57.62 million in FY 2014; $415.89 million over 5 years; and
$1.39 billion over 10 years. These costs are consistent with those
estimated in the FY 2014 President's Budget.
s. 1579--scra enhancement and improvement act of 2013
S. 1579 would amend the Servicemembers Civil Relief Act (50 U.S.C.
App. 501, et seq.) to expand protections for servicemembers and their
families under that act with respect to installment contracts,
mortgages, professional licenses, taxes, and credit and seek to improve
provisions relating to enforcement. This bill has little effect on VA
programs. This bill would largely affect issues relating to current
members of the uniformed services and consequently is primarily of
concern to DOD, Homeland Security, Health and Human Services, and
Commerce. The bill would further relate to matters of Department of
Justice enforcement. Accordingly, we defer to those departments' views
on this bill.
s. 1581--survivors of military sexual assault and domestic abuse act of
2013
Section 2 of the bill would expand VA's authorization to provide
counseling and care needed to recover from experiences of military
sexual trauma (MST) to include active duty Servicemembers as well as
Veterans. Section 2 would also specify that eligible members of the
Armed Forces would not be required to obtain a referral to access these
services. VA has significant expertise in treating MST-related health
conditions and believes that expanding authorization to include
Servicemembers would benefit this population. VA supports the goals of
this provision but has concerns about the costs and additional staffing
that could be required if the bill is enacted. We also recommend the
Committee solicit input from the DOD.
We note that VA and the draft bill define MST to include sexual
assault and sexual harassment experienced during military service.
Thus, VA believes the bill may be more appropriately named the
``Survivors of Military Sexual Trauma and Domestic Abuse Act of 2013.''
VA currently provides MST-related care free of charge to eligible
Veterans. Under current law, VA may provide care (including MST-related
care) to Servicemembers, but VA must recover the cost of that care. The
bill would require VA to develop a national infrastructure for tracking
MST-related care provided to Servicemembers, and VA and DOD would need
to collaborate to develop monitoring and other processes related to
eligibility, billing and care coordination. The bill would also greatly
expand the work of VA's MST Coordinators. VA is still analyzing this
provision and will provide costs upon completion of this work. VA
assumes section 2 would require VA to recover the cost of providing
MST-related care to Servicemembers from DOD.
Section 3 of the draft bill would require, not later than 540 days
after the date of the bill's enactment, that the Secretary of Veterans
Affairs develop and implement a screening mechanism by which to detect
if a veteran seeking VA health care services has been a victim of
domestic abuse. It would require such information to be used to improve
the treatment of the veteran and to assess the prevalence of domestic
abuse in the veteran-population. The draft bill would set forth a broad
definition of ``domestic abuse'' for purposes of this section.
Specifically, that term would mean:
(1) Behavior with respect to an individual that constitutes a
pattern of behavior resulting in physical or emotional abuse, economic
control, or interference with the personal liberties of that
individual; or a violation of Federal or State law involving the use,
attempted use, or threatened use of force or violence against that
individual; or a violation of a lawful order issued for the protection
of that individual; and
(2) Is committed by a person who is a current or former spouse or
domestic partner of that individual; shares a child in common with that
individual; is a current or former intimate partner of that individual
that shares or has shared a common domicile with that individual; is a
caregiver of that individual as defined by 38 U.S.C. 1720G(d); or is in
any other type of relationship with that individual that the Secretary
may specify for purposes of this section.
VA supports section 3 of the bill. The Center for Disease Control
defines intimate partner violence (IPV) as actual or threatened
physical, sexual, or psychological harm or stalking behavior by an
intimate partner that may vary in frequency and severity (Saltzman,
Fanslow, McMahon, & Shelley, 1999). Research indicates higher rates of
these incidents for women Veterans, and that these are likely
underestimated because of underreporting. Research has also shown the
relationship between IPV and poor medical and mental health outcomes.
Most major medical organizations, including the Institutes of Medicine,
recommend routine screening for IPV.
VA is uniquely poised to implement universal screening and
coordinate provision of appropriate referrals and intervention for IPV
among women Veterans, given its strong track record of universal
screening and integrated primary and mental health follow-up care for
depression, Post Traumatic Stress Disorder, and MST. VA supports
establishing MST screening for all Veterans, but we note that research
is lacking on the best strategies for screening for male patients.
Therefore VA's screening efforts would focus initially on intimate
partner violence for women Veterans, while strategies for MST screening
for male Veterans are being further studied.
Section 4 would require VA to submit a report to Congress on the
treatment and services available for male veterans who experience MST
(as defined by 38 U.S.C. 1720D) as compared to that available for
female Veterans. This report would be due not later than one year after
the date of enactment of this Act. That report would also have to
include a detailed report on domestic abuse among veterans that address
all of the specified reporting elements set forth in that section.
Section 4 would also establish a detailed reporting requirement for the
VA/DOD Joint Executive Committee (JEC) (commencing not later than one
year after the date of the Act's enactment and annually thereafter for
5 years) that identifies the processes and procedures used to
facilitate the transition of individuals receiving treatment for MST
and domestic abuse from DOD's health care system to VA's. The JEC
report would also have to describe and assess the collaboration between
VA and DOD in assisting Veterans file disability claims related to MST
or domestic abuse including permitting Veterans access to information
and evidence necessary to develop or support such claims.
With respect to section 4(a) of the bill (requiring a report on the
treatment and services available for male veterans who experience MST),
VA supports this requirement but believes it would require a
comprehensive data collection effort to ensure an adequate assessment
is accomplished. VA is working to develop this cost estimate and will
provide to the Committee as soon as it is available.
Regarding section 4(c)(2), VA does not object to providing future
reports with a ``description and assessment'' of the ongoing
collaboration between VA and DOD ``in assisting veterans in filing
claims for disabilities related to military sexual trauma or domestic
abuse, including permitting veterans access to information and evidence
necessary to develop or support such claims.'' However, although VA
does not object to providing such reports, it is unclear why such a
reporting requirement is necessary. Collaboration between VA and DOD
already exists as a significant element in the adjudication process of
MST claims and is not likely to change considerably in the future.
Furthermore, VA is already required under 38 U.S.C. 5103 to inform
claimants about what information or evidence, whether military or non-
military, is needed to substantiate their claims. In addition, VA has a
statutory obligation under 38 U.S.C. 5103A to ``make reasonable efforts
to assist a claimant in obtaining evidence necessary to substantiate
the claimant's claim for a benefit under a law administered by the
Secretary.'' Veterans have access to their own VA disability claim
files, and the Freedom of Information Act and Privacy Act provide
additional avenues to procure information and evidence maintained by
Government entities.
VA estimates that costs associated with section 4(c)(2) would not
be significant because VA does not anticipate changes to established
procedures. However, preparing the reports would entail a cost and
would divert resources from addressing the disability claims backlog.
s. 1583--mental health support for veteran families and
caregivers act of 2013
S. 1583 would require the Secretary, not later than 270 days after
enactment, to establish an education program and a peer support program
for the education and training of family members and caregivers of
enrolled Veterans with mental health disorders. Under the education
program and the peer support program, the Secretary would provide a
course of education peer support, respectively, to family members and
caregivers of eligible Veterans on matters relating to coping with
mental health disorders in Veterans.
The education program would be carried out for four years and could
be extended by the Secretary for an additional four-year period. The
program would initially be carried out in not less than 10 VA medical
centers, not less than 10 VA clinics, and not less than 10 Vet Centers,
with consideration given to selecting locations in rural areas, areas
not in close proximity to an active duty installation, and areas in
different geographic locations. Not later than 2 years after
commencement, the Secretary would be required to expand the number of
facilities at which the program is carried out to additional VA medical
centers, VA clinics, and Vet Centers. In carrying out the program, the
Secretary would be required to enter into contracts with qualified non-
profit entities to offer the course of education. Such entities would
have experience in mental health education and outreach, including work
with children, teens, and young adults, and would meet other specified
criteria. Priority would be given to qualified entities that use
Internet technology for the delivery of course content in an effort to
expand availability of support services, especially in rural areas. The
course of education would consist of not less than 10 weeks of
education and include specified elements. Instructors would be required
to maintain a level of proficiency as determined by the Secretary and
submit proof of such proficiency as the Secretary determines
appropriate. VA mental health care providers would be selected by the
Secretary to monitor, in consultation with primary care providers, the
progress of the instruction by meeting quarterly with instructors. Each
VA mental health care provider selected would be required to submit a
progress report to the Secretary not less frequently than semiannually.
The Secretary would provide peer support under the peer support
program at each location where education is provided under the
education program. Peer support would consist of meetings in group
settings between a peer support coordinator and family members and
caregivers; the meetings would be conducted not less than twice each
calendar quarter. Peer support coordinators would be selected among
individuals who successfully completed the course of education, and
would maintain a level of proficiency as determined by the Secretary
and submit proof of such proficiency as the Secretary determines
appropriate. A VA mental health provider would be selected by the
Secretary to serve as a mentor to each peer support coordinator. VA
mental health providers selected to monitor instruction under the
education program would monitor the progress of the peer support
program by meeting quarterly with peer support coordinators, and would
be required to submit a progress report to the Secretary not less
frequently than semiannually.
The Secretary would be required to conduct a comprehensive and
statistically significant survey of the satisfaction of individuals
that have participated in the course of education and individuals that
have participated in the peer support program. Not later than one year
after commencement of the education program and by September 30 each
year thereafter until 2017, the Secretary would be required to submit a
report on the education program and peer support program to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives. Each annual report would include specified elements,
including information compiled as a result of the surveys. Not later
than one year after completion of the education program, the Secretary
would be required to submit to the Committees on Veterans' Affairs of
the Senate and the House of Representatives a report on the feasibility
and advisability of continuing the education program and the peer
support program, including specified elements.
VA applauds the Committee's attention to the important topic of
support for family members and caregivers of Veterans. However, because
we believe VA's programs now fulfill the goals of the bill, we do not
support S. 1583. VA is already engaged in multiple programs to educate
and support family members and caregivers of Veterans from all eras
with a mental health disorder. For example, VA's Family-to-Family
Education Program (FFEP) was established in partnership with a non-
profit entity, the National Alliance on Mental Illness (NAMI), to
provide an education program and peer support program for the education
and training of eligible family members and caregivers of Veterans with
a mental health disorder. The FFEP consists of a 12-week program and
includes general education on different mental health disorders,
techniques for handling crisis situations, techniques for coping with
individuals suffering from mental health disorders, and information on
resources. NAMI FFEP teachers are peer-instructors who have personal
experience in successfully coping with family problems and who complete
3.5 days of training. During the period of December 2010--2013, the
education program was implemented in 84 VA facilities, including CBOC
and rural sites. FFEP is a remarkably successful peer program and is
built around the values of inclusion and empowerment for everyone
concerned. Research on FFEP outcomes has shown an increase in
empowerment, knowledge about mental illness and problem solving skills,
and a decrease in general anxiety.
Other collaborations include VA's partnership with the National
Council on Aging, through which VA provides Building Better Caregivers/
TM/--a web-based online training and support workshop for eligible
family caregivers of Veterans of all eras. To date, more than 1,500
family caregivers of Veterans have been referred to the 6-week program.
This training provides specific content for family caregivers of
Veterans and is facilitated by family caregivers.
Other VA programs also facilitate education and support of eligible
family members and caregivers of Veterans with a mental health
disorder, including under the Continuum of Mental Health Services
(MHS), VA's Caregiver Support Program, and the Readjustment Counseling
Service.
VA's MHS offers eligible family members and caregivers Veteran-
Centered Brief Family Consultation, Family Psychoeducation (Behavioral
Family Therapy and Multiple Family Group Therapy), and several
different models of Marriage and Family Counseling. MHS has also
nationally disseminated two clinician-led family education models for
individuals with mental health conditions--Support and Family Education
(SAFE), which is an 18-session program, and Operation Enduring
Families, which is a 5 session program that is focused on family
members of Veterans of Operation Enduring Freedom, Operation Iraqi
Freedom, and Operation New Dawn.
Through VA's Caregiver Peer Support Mentoring Program,
approximately 150 eligible family caregivers of Veterans are engaged in
peer support activities. Many of the family caregivers who serve as
Caregiver Peer Support Mentors are family caregivers of Veterans with a
mental health disorder. Also, in June 2012, VA's Caregiver Support
Program provided a training utilizing VA's satellite broadcast network
for family caregivers of Veterans with Post Traumatic Stress Disorder
(PTSD). The training was led by a subject matter expert from VA's
National Center of Excellence on PTSD and included specific training on
supporting Veterans with PTSD, as well as coping techniques and skills
for family caregivers. The format included a training session followed
by 40 minutes for a question and answer session. The course was viewed
live by more than 590 family caregivers at approximately 100 VA sites.
Given its success, the Caregiver Support Program has provided
additional training for family caregivers using this method including a
broadcast on Traumatic Brain Injury and a broadcast on Pain Management.
The broadcasts are videotaped in order for them to be provided to
family caregivers who were unable to attend the broadcasts.
Additionally, Vet Centers provide readjustment counseling to family
members of eligible Veterans when found to aid in the readjustment of
the Veteran and can include individual, family, and group counseling,
as well as psycho-education to help families understand the war-related
readjustment issues, such as PTSD, that their Veterans face. As of part
of the group counseling available to families, many Vet Centers make
available family support groups. Vet Centers are known for their high
percentage of employees who have served in the military which aid in
ability to create a peer to peer or Veteran to Veteran relationship;
the program also employees many family members of Veterans who bring
those experiences to the clinical work that they provide. Veterans and
their families who present to Vet Centers with serious mental illness
are referred to VHA Medical Facilities for appropriate care.
Finally, we note that section 2(a)(2)(A) of the bill would define
``family member'' and ``caregiver'' as those terms are defined in 38
U.S.C. 1720G(d). However, the definitions of those terms in section
1720G(d) apply with respect to an eligible Veteran under section
1720G(a), (and in the definition of ``caregiver'' also with respect to
a covered Veteran under section 1720G(b)). We believe this creates some
ambiguity as to which family members and caregivers would be eligible
under the bill. We therefore recommend that either section 2(a)(2)(A)
of the bill be clarified to indicate that the education and peer
support under the bill would be limited to family members and
caregivers participating in the programs under 38 U.S.C. 1720G, or the
bill be revised accordingly if it is intended apply to a broader
population of family members and caregivers.
VA is still examining the potential costs of this draft bill.
s. 1586--enhanced dental care for veterans act of 2013
Section 2 would authorize VA to provide additional benefits to
Veterans who are eligible to receive dental services, treatment, and
related appliances under section 1710(c), U.S.C., when they are needed
to restore functioning in a Veteran that is lost as a result of any
dental services or treatment provided under that section. VA supports
section 2 in the interest of fairness to the Veteran. This is a
responsibility that VA should bear, not the Veteran.
Section 3 of the bill would establish a 3-year pilot program at not
fewer than 16 sites to assess the feasibility and advisability of
furnishing the same dental care benefits now available to veterans with
service-connected disabilities rated 100 percent disabling to enrollees
who are not otherwise eligible for such services and treatment under
current authorities. The pilot sites would need to include four VA
medical centers with established dental clinics, four VA medical
centers with current contracts for such dental care and services, four
CBOCs with space available for such purposes, and four facilities
selected from among federally Qualified Health Centers and Indian
Health Service (IHS) Facilities with established dental clinics (of
these, at least one must be an IHS facility selected in consultation
with the Secretary of Health and Human Services). In selecting sites,
the Secretary would be required to consider the feasibility and
advisability of selecting locations in each of the following areas:
rural areas, areas not in close proximity to an active duty military
installation, and areas representing different geographic locations.
Participation in the pilot program would be voluntary and at a
Veteran's election.
The terms of section 3 would also limit the amount of expenditures
the Secretary could make for a Veteran-participant in any one-year
period to the amount the Secretary determines appropriate (as
determined in consultation with the Director of IHS and the Director of
the Centers for Medicare and Medicaid Services if one or more FQHCs are
selected as sites). The Secretary, however, could not set that amount
below $1000.
Section 3 would also permit VA to collect copayments for dental
care provided to Veterans under the pilot program in accordance with
current title 38 copayment authorities for VA medical care; require the
Secretary to inform all eligible veterans of the services and treatment
available under the pilot program; and authorize the Secretary to enter
into contracts with appropriate entities for the provision of dental
services and treatment under the pilot program.
VA cannot support 3. Even as a 3-year pilot program, it would
represent a major expansion of services that VA could not realistically
accommodate, in terms of necessary staff, capital capacity or budgetary
resources. Current demands on our dental program already match, if not
exceed, our current capabilities and resources. Were an entirely new
group of Veterans eligible to enter the dental system, it is doubtful
we could meet their dental needs (whether done through contracting or
in-house). By diverting program resources to the pilot program, we
would also need to decrease dental benefits available to other eligible
populations, thus creating a barrier to their access to care. Of
course, these concerns become even more acute should the pilot expand
to become a national program without such geographic limitations.
Furthermore, should financial resources or additional
appropriations be provided for this pilot program, the cost and time
needed to expand the dental program would push back the start of the
pilot program far beyond what seems contemplated by the bill.
Operationalizing the pilot would require significant additional
resources not only in terms of personnel but also in terms of needed
infrastructure and durable capital costs--none of which is included in
the bill. Relying instead on the private sector to provide this
additional care would increase per patient costs, perhaps even greater
than is currently experienced. If enacted, VHA would have no choice but
to relinquish some care planning oversight to the private sector to
carry out this pilot program.
Without additional resources and funding, VA's ability to provide
dental services to this new cohort of Veterans would be seriously
compromised and require a shifting of available resources to the
detriment of others. Based on our experience, extending eligibility to
this new group of Veterans would predictably result in ``front
loading'' demand, much as we are now experiencing with Veterans who are
newly eligible for dental care due to increases in their service-
connected ratings. In short, the pilot sites would be quickly
overwhelmed by this new cohort's dental needs and their needs would
largely go unmet. The dental benefits intended to be delivered under
the pilot program would simply not be available.
In addition, the pilot program that would be established in section
3 raises equity concerns. Only enrollees fortunate to be served by a
selected pilot site would be eligible for the dental benefits described
in the bill, while equally deserving enrollees outside of those
catchment areas/sites would still lack eligibility for needed dental
care. While pilots by their nature are selective, we believe the desire
for these services may be so acute that it will create stronger than
usual immediate inequities, as well as expectations regarding future
availability of these benefits across the country that will be
difficult to fulfill.
Fortunately, another option exists by which the dental needs of
these Veterans could be addressed. The Dental Insurance Pilot Program
(DIPP) currently allows enrolled Veterans to buy dental insurance for
use in receiving care in the private sector. This pilot is starting
November 15, 2013, and enrollees who are not currently eligible for VA
dental benefits could take advantage of this opportunity.
Section 4 would require VA to conduct an educational program
promoting dental health for enrollees. The program would include
specified information disseminated through mechanisms described in the
bill. VA supports section 4 of the bill as a favorable means by which
to promote dental health. In fact, VA has already initiated some of
these efforts and would welcome the opportunity to do more in this
area.
Section 5 would require VA not later than 180 days after the date
of the Act's enactment to expand the current DIPP to include a
mechanism by which private sector dental care providers may forward to
VA (for inclusion in the patient's VA electronic medical record)
information on the services they provide, when the Veteran has elected
to participate in the use of this mechanism. Section 5 also authorizes
VA to extend the pilot program by 2 years if needed to assess this
mechanism.
Although VA would welcome an extension of the DIPP for reasons
unrelated to the bill, we do not believe the requirement for DIPP
contracts to include a mechanism by which to allow submission of
information to VA (for inclusion in the Veteran's individual electronic
medical record) is needed. Veterans can already submit private medical
records, including dental ones, into their personal electronic medical
record.
Such a requirement would impose administrative disruptions and
could have unintended consequences on dental care. Namely, it would
alter contracts now in place, potentially requiring them to be re-
competed. In addition, it could result in the direct costs associated
with use of such a mechanism being passed on to Veterans, as the dental
insurance carriers would likely recoup theirs and providers' costs
through billing of increased premiums. This type of requirement could
also limit the providers who are willing to accept VA dental plans,
thereby hampering or minimizing Veterans' access to private dental
care, thus defeating the purpose of the DIPP.
If enacted, this bill, particularly the provisions of section 3,
would have very significant budgetary impact. We will provide our cost
estimate to the Committee as soon as our analysis is completed.
s. 1588--reimbursement for emergency medical treatment
VA supports S. 1588, which would expand eligibility for
reimbursement for non-VA emergency care for nonservice-connected (NSC)
conditions when the enrolled Veteran seeks but does not receive VA
health care in the 24-month period preceding the emergency treatment
because VA was unable to provide a new patient examination in time for
the Veteran to fall within the 24-month window in current law.
Currently, Veterans who are otherwise eligible for coverage under
38 U.S.C. 1725 are deemed ineligible for this reimbursement if they
have not been seen at a VA health care facility within the preceding 24
months, for any reason. VA believes that Veterans should not lose
eligibility for reimbursement if they seek VA care within that 24-month
period but, for reasons attributable to VA, do not receive a new
patient examination in time for the Veteran to satisfy the 24-month
requirement. S. 1588 is consistent with this view. VA estimates this
bill would result in an additional expenditure of $21.6 million over a
10 year period.
s. 1593--servicemember housing protection act of 2013
S. 1593 would amend the Servicemembers Civil Relief Act to expand
protections for servicemembers with regard to residential leases and
for their survivors with regard to mortgage foreclosures. This bill has
little effect on VA programs. This bill would largely affect issues
relating to current members of the uniformed services and consequently
is primarily of concern to the DOD, Homeland Security, Health and Human
Services, and Commerce. Accordingly, we defer to those departments'
views on this bill.
s. 1604--veterans health care eligibility expansion and
enhancement act of 2013 (revised)
Section 2 of the bill would amend 38 U.S.C. 1710(a)(3) by replacing
``may, to the extent resources and facilities are available'' with
``shall.'' If section 2 were enacted the Secretary would be required to
furnish hospital care and medical services to all Veterans, albeit some
Veterans (those covered by 38 U.S.C. 1710(a)(3)) would have to pay
copayments for this care. As amended, subsection (a)(3) would also
specify that the Secretary shall furnish necessary nursing home care to
Veterans not covered by (a)(1) or (a)(2). Currently under 38 U.S.C.
1710, the Secretary's authority to furnish nursing home care to
Veterans covered by subsection (a)(2) and (a)(3) is discretionary.
Mandatory nursing home care is addressed in 38 U.S.C. 1710A. As
drafted, Section 2 could be read to expand the mandatory nursing home
population to include veterans covered by 1710(a)(3).
VA reads 38 U.S.C. 1710 in conjunction with 38 U.S.C. 1705. While
section 1710 authorizes VA to provide hospital care and medical
services, section 1705 specifies how VA is to manage the system of
patient enrollment. Although the language in section 2 would not impact
the Secretary's authority to manage the enrollment system, if all
Veterans are considered to have mandatory eligibility the continued
effect of the enrollment system is unclear. Until VA has the
opportunity to further discuss the intent of the provision with the
Committee, it cannot support nor provide cost estimates for section 2.
As we noted in our testimony, section 3 of the bill requires
detailed consultations with other Federal agencies. VA reserves
analysis of those issues for a later time, including the opportunity to
discuss them with the Committee.
Section 4 of the bill would expand the combat eligibility provision
in 38 U.S.C. 1710(e)(1)(D) for Veterans discharged after January 28,
2003, from 5 years from the date of the Veteran's discharge to 10
years. Section 4 would also extend eligibility for Veterans who were
discharged before January 28, 2003 until January 27, 2018. Section 4 of
the bill is currently being evaluated and costs associated to this
provision are under consideration. VA has had extensive conversations
with the Chairman and staff, who realize the complexities of the
provision. VA will provide views and costs on the measure at a later
time. We look forward to continuing discussions with the Committee.
Section 5 would delete 38 U.S.C. 1710(a)(4) and add similar
language to 38 U.S.C. 1707. These amendments do not appear to make
substantive changes to eligibility for VA health care or VA's
enrollment system. However, if enacted, we recommend that the phrase
``subject to paragraph (a)(4)'' in 38 U.S.C. 1710(a)(1) and (a)(2) be
amended to reference the new provisions of 38 U.S.C. 1707. In addition,
we would also recommend that a similar reference be added to 38 U.S.C.
1710(a)(3), as amended by section 2 of this bill.
Section 6 of the bill would direct VA to make certain modifications
for purposes of determining whether veterans qualify for treatment as
low income families for enrollment under 38 U.S.C. 1705(a)(7).
Specifically, the income thresholds applicable to Priority Group 7
would be modified so that one low income threshold would be applied to
a State, equal to the highest ``low-income'' threshold among the
counties within that State. The ``geographic means threshold'' (GMT),
which is based on calculations done by the Department of Housing and
Urban Development, is currently based on 80 percent of the local median
income. This bill would set a statewide threshold at 80 percent of the
median income in the highest earning locality in a state (at the
Metropolitan Statistical Area).
Equalizing GMT thresholds across broader geographic regions would
likely make the eligibility criteria easier to understand and appear
more equitable among Veterans residing in close proximity within a
State. However, significant differences in the GMT thresholds across
state boundaries will still be possible. Also, by increasing the GMT
thresholds, a significant number of current enrollees in Priority 8
will be re-classified as Priority 7 and thereby enjoy the lower
inpatient copayment levels associated with Priority 7. This will result
in a substantial reduction in ``first party'' revenue. In addition,
increasing the GMT thresholds would also expand the pool of Veterans
eligible for enrollment in Priority Groups 7 and 8, many of whom are
not currently enrolled. VA estimates that approximately 1.8 million
Veterans would fall into the newly expanded Priority 7 income window,
of which approximately 1.4 million are not yet enrolled. VA cannot
support section 6 without further discussion of the effect of such an
increase in enrollment would have on the care provided to currently
enrolled Veterans, as well as the budget resources that would need to
be made available to support such an expansion. VA estimates the cost
of section 6 of the bill would be $370 million over 5 years and $3.3
billion over 10 years.
Section 7 of the bill would require VA to use the capitation-based
resource allocation model in entering into contracts for the furnishing
of health care services. This would be a substantial change to the
payment structure for non-VA medical care. VA needs to retain
flexibility for its payment models and therefore does not support this
provision.
VA estimates that there would be no specific costs associated with
this provision. However, VA typically sends care out to the community
when it cannot be provided in the VA. Therefore, it is usually episodic
in nature. A capitation-based payment methodology generally is more
cost-efficient when used to pay for a complete treatment cycle for a
diagnosis, but may not be for episodic care.
Chairman Sanders. Thank you very much for your testimony.
Let me begin with a few questions with Dr. Jesse. In your
judgment, does the VA provide good quality, cost-effective
health care? I know you are not objective about this.
Dr. Jesse. Well, I would say that if I did not feel that it
did I would not be in the position I am in now. We know that
things happen in VA. You mentioned that earlier. If you look
across health care systems and compare in the objective ways
that we can, VA provides excellent care in many of the areas by
which we measure the effectiveness and the quality of health
care in the US. So, on that basis, that objective basis, I
would say yes, we do.
Chairman Sanders. And consumer satisfaction is fairly high,
is it not?
Dr. Jesse. Consumer satisfaction is fairly high. It is not
as high as we would like it to be; but when you compare
satisfaction with the care in the VA system to other large
health care systems, in many respects they are comparable.
I think a lot of our efforts are really being driven now
toward improving that consumer satisfaction. Much of the
strategic issues that we are moving forward in VA health care,
starting a year or so ago but moving rapidly forward now, are
really focused on building a health care system that is driven
by the patient and their individual needs, not by the
statistics of large numbers or meeting the needs of the health
care system.
Chairman Sanders. Let me ask you this.
Dr. Jesse. Sure.
Chairman Sanders. My impression is that there are many
veterans who would like to get into the system but for a
variety of reasons do not. Some of them get to the issue that
we discussed a moment ago about outreach and some of them do
not even know the benefits to which they are entitled.
I think VA is beginning to do a good job. We will probably
have a hearing on that issue but I think we are making some
progress in at least informing veterans of the benefits to
which they are entitled.
But my impression is that there is a lot of confusion about
eligibility levels. In Vermont, if Senator Begich were to live
in one county and I live literally a mile away from him in
another county, he might be eligible; I might not be eligible.
I think that makes it difficult for folks to do outreach work.
So, my impression is in Vermont, and I suspect around the
country, that there are a lot more veterans who would like to
access VA health care than are able to do so today.
Do you agree or not?
Dr. Jesse. I will agree at least anecdotally because I hear
much of the same things that I think you are hearing. I cannot
quantitate it, but I do know--and particularly of interest is
people who would be in what we call category eight who are not
eligible based on a means test, who are perplexed because they
say I would love to get my care in the VA.
Chairman Sanders. Exactly.
Dr. Jesse. And VA would actually bill their insurance
company so we would not be costing more money. But the way we
are stratified, it does not allow us to do that.
Chairman Sanders. So, one of the areas that we are going to
work on is to expand and simplify VA health care. One of the
folks who works for me in Vermont gave me a telephone book. It
was literally a telephone book. What do we do now? Every zip
code or something. Is that the eligibility level?
Dr. Jesse. I am not sure exactly how that works. I might
want to defer to the benefit side.
Chairman Sanders. So, if I live in one zip code and Senator
Begich in another, our eligibility levels are different? I
believe that is the case, is it not?
Mr. McLenachen. Mr. Chairman, are you asking about health
care eligibility?
Chairman Sanders. Yes.
Mr. McLenachen. I would have to defer to----
Chairman Sanders. Ms. Joyner. All right. We are going to
find it. Mr. Hipolit, you are next.
Ms. Joyner. Actually, I am not sure exactly what the
criteria is. We could take that for the record and get it back
to you.
Chairman Sanders. Well, there is a telephone book, and it
is pretty crazy and pretty complicated.
Ms. Joyner. It is very complicated, yes.
Chairman Sanders. If our goal is to simplify and bring
people into the system, a telephone book which has his income
level different than mine and we live two miles apart makes no
sense at all to my mind. So, we are going to work on that.
I want to switch gears for a moment. I am going beyond my
time here, and ask, Dr. Jesse, if you consider lack of access
to dental care a serious problem in our country and for
veterans?
Dr. Jesse. It is a serious issue in our country; and by
that very nature, it is an issue for veterans. I am a
cardiologist. It has been known for 20 years that periodontal
disease has a linkage to heart attacks, for instance. It
creates a systemic inflammatory state which drives a number of
different issues.
So, dental health is part of a holistic approach to health
as in all other forms. So, yes.
Chairman Sanders. Right. Would I be wrong in assuming that
if we said--and I understand this is an expensive proposition,
and I understand that we cannot do it all tomorrow--but what
would your reaction be if we said to veterans around this
country that we understand health care to include dental care?
We know that many of those folks have serious dental problems
and they cannot afford treatment elsewhere and that we were
going to open up VA facilities to non-service-connected as well
for dental care.
Do you suspect there will be a lot of people who would be
interested in taking advantage of that opportunity?
Dr. Jesse. That I would not even suspect. I can tell you
that there would be. I have patients, I still see patients,
that are in exactly that bind that you discussed. We can
provide complex heart attack care for them, but we cannot
provide relatively simple dental care.
Chairman Sanders. Ok. So, I would look forward to the
cooperation of Members on the Committee on this. This is an
issue, I think, that is long overdue and it needs to be
addressed. My time has expired.
Senator Johanns.
Senator Johanns. Thank you, Mr. Chairman, and to the panel,
thank you for being here today.
Let me start out and say I have no quarrel with the Chair's
assertion and your assertion, Dr. Jesse, that there is quality
care at the Veterans' Administration. All of us have seen some
of the most remarkable things.
I would go as far as to say that not only is it quality
today, it continues to improve and in some areas it is
trendsetting. Everybody looks to the VA to see how you are
doing things to try to put that in practice at their health
care center.
But I do have a question about facilities because in my
State, we are on some kind of list relative to a veterans
hospital that services Nebraska and western Iowa. I think we
are 18th out of 20 on this list. I do not even know if anybody
can predict when you get to the 18th but rest assured I will be
a much older man before that facility gets started.
Here is the point I want to make, and I would like
whoever's reaction to this. I have traveled the State of
Nebraska as a Governor and now as a Senator. One of the first
things that communities want to show me is their health care
facility. I have been in some of the smallest communities in
Nebraska, and they will take me to their hospital.
It is remarkable what they are doing with this small
critical access hospital. It is a beautiful facility. It was
just built within the last, you know, 5, 10, 15 years.
Unbelievable. And I will go down the road 50 or 75 miles and I
will see it again.
By comparison, I go to the VA hospitals, and I will just
tell you I do not think they are up to standard. They are 1940-
1950s style hospitals. You go in the operating room, and God
bless the doctors and nurses and the health care providers, but
they are working in conditions that I just think are not up to
today's standards. These facilities are way out of date.
The VA is in this very difficult situation of patch, patch,
patch; and it seems like wasted money. Here you have this
building that really, really should not be standing anymore and
we are putting millions and millions of dollars into it.
I am offering this in a global sort of way because I do not
want this to sound completely about my State because I think I
could find this in most any State in the country.
How do we go about solving that problem because, like I
said, if we stay at 18th, you know, it is almost like giving up
hope that we will ever move up in the list. Give us some advice
on how we can match our health care facilities with the
capability of the health care providers that are working with
our veterans in those other beautiful facilities.
Dr. Jesse. Sir, I want to, if I may, take two approaches to
that. One is that you are absolutely correct in that many of
these facilities do not just appear old, but they are old and
become difficult to maintain.
I would like to say, though, that what is at the cosmetic
end of this is not necessarily what is behind the wall. So, how
our ORs conform to modern standards for air flow, infection
control, et cetera, part of the issue is it is very expensive
to maintain them in those ways. It is very expensive in these
old hospitals to run the kind of channels that you need for
modern electronics, communications systems, et cetera, at these
places.
The simple answer, which is not intended to sound facetious
but is it takes money. In some respects, it may well take a
reconfiguring of the approach we have to health care in the
small communities.
I am a huge fan of the critical access hospital system. I
am hugely concerned that there are at times in this country the
concern that the surrogate for quality is volume and that
nothing good happens in small places, and I do not think that
is the case at all.
I think, amongst other things in VA, what we have shown is
if we can manage quality, by managing quality we can do great
things in small places. In terms of the building out, though,
and how we distribute our footprint in ways that is most
acceptable, again there is going to be some rethinking about
what those facilities look like.
There is going to be a greater use of health care delivery
systems without having to come to a hospital. So, we can use
those face-to-face resources, those hands-on resources in the
most optimum ways and say frankly in your State and any State
that is considered rural, people do not have to travel the
kinds of distances they need to.
But in terms of how we prioritize new construction, new
facilities, we have a process, a fairly formal process for
doing that. It is fundamentally driven around safety, patient
safety.
One of the things we have learned is that you can always
put somebody at the bottom of a list if that is the only thing
that you drive on; and we are actually now working through
processes to better bring up, you know, these other needs
rather than just driving everything solely on patient safety
and physical safety and on facility safety.
Senator Johanns. Mr. Chairman I am out of time on this but
I bet you I strike the chord with everybody. Just as a
respectful suggestion it may justify a hearing to try to figure
out how best to proceed because, like I said, this is not
unique to Omaha, Nebraska.
Chairman Sanders. I think you are right. It is not unique.
What we have to deal with is money. It is an expensive
proposition but long term it may be cost-effective rather than
patching up older buildings is what you are saying.
Senator Johanns. Yes.
Chairman Sanders. Thank you very much, Senator Johanns.
Senator Hirono, would you mind if Senator Begich makes
opening remarks?
Senator Hirono. Sure.
Chairman Sanders. Thank you very much.
STATEMENT OF HON. MARK BEGICH,
U.S. SENATOR FROM ALASKA
Senator Begich. Thank you very much, Mr. Chairman. Thank
you, Senator Hirono, for allowing me since I have to run off.
I want to follow up on Senator Johanns' comments for a
second.
But to the panel here, thank you. I know there are some
issues you have with a couple of bills I sponsor. One is a
whole effort to create outreach for veterans especially in
rural areas which is a big demand and I know there are some
pieces to the equation. I would love to get your input
additionally as we work through this because it is critical
especially in rural Alaska.
We find veterans on a regular basis that do not have access
or are totally unaware of what benefits they are owed based on
their service. In rural Alaska it continues to be a problem and
I know it happens in other States. So, I would like to further
work with you on Senate Bill 1558.
The other one is S. 1580, which is pretty simple. This one
is when we work with facilities that have--we are using a per
diem payment regarding homeless veterans. As mayor I had to
call the fire department more than once for inspections on
facilities that are contracted with VA to, in theory, provide
shelter for the homeless which sometimes fall below standards.
Now, I know you all kind of do this process now, so this
bill will just codify that, make sure that is the law, that you
cannot pay a per diem to a facility that is not meeting safety
standards of the local community they are stationed in. I know
you do that informally now but we want to make sure it is
codified.
We also want to require that when you then stop making
payments, this Committee and the House Committee is notified so
people understand it because obviously you will get calls
immediately. I can just tell you as a former mayor that is
something that I noticed more than once.
So again, I wanted to note those bills and I thank you.
A third bill which we were going to discuss today but was
pulled off because we have to work on some language, goes to
this facilities issue in the longer term.
First, I want to commend the VA because of the work you
have done with our State and now expanding that to the Indian
reservations. We will never see, I would love to see a
veterans' hospital in my State. But if Nebraska is number 18,
we are probably number I do not know what.
So we have tried to do something a little different that
the VA has worked with us in kind of like a--if I can say this
word, I am not sure it is the right word, but--a demonstration
of seeing if this would work.
We have been in health care service facilities, beautiful
facilities. As a matter of fact, I just visited one in
Fairbanks that had 22 dental health stations, and I mean top-
quality dental health stations.
So, what we have been able to do with 26 of our tribes by
working with the VA--now if you live, for example, in Nome, AL,
again there's a beautiful, brand-new hospital built by the
Indian health services serving multiple tribes. It is non-
accessible by road from any major urban area but in that region
several thousand people are living. 800 are veterans.
Now that veteran has a choice. They can walk into that
facility, get service, VA will reimburse them, or fly to
Anchorage or Seattle where the VA clinic and the VA hospital is
located but they still get a choice.
The best news is, it is not only Indian health services for
native veterans. It is also for non-native veterans, this new
experiment which so far from what I am hearing has been
working. You have a line item in your budget now to allocate
resources to this. It is also now being considered for
expansion to Indian reservations, which is a very complex
situation.
So, you have an Indian health service facility right there
but in order to go to the VA facility you have to pile into a
van, go drive out to it, wait for everyone to get their
services, then get back in the van and drive back out.
I think there are some innovative approaches here in one of
the bills that we drafted--we are tweaking some language on
it--which will create this opportunity. For example, we have
another beautiful hospital finished by Indian Health Services
in partnership with our tribal consortium, and the top floor is
empty.
But the VA clinic down the street is packed beyond
capacity. So the thought is to let us put them together,
because as long as quality care is there--and that is the key
here--I think we can leverage our assets much differently.
I want to thank the VA for being willing to take on this
experiment. I know there is a little concern not just by you
but by other national organizations because they were concerned
about the privatization of VA, and they were concerned about
the quality of care because there is inconsistent care within
the Indian health services just like the VA. Even though we are
trying to get to a high standard, there is inconsistent care.
The program we have in Alaska for Indian health care
service is such a model. Internationally, folks look at it.
They fly from around the world to come to see our Indian health
care service delivery system. I know you guys have gone to it
to borrow some of our telemedicine.
Dr. Jesse. South Central.
Senator Begich. Yes, the South Central clinic.
So, I just wanted to put that out there because I think at
this point, and it is actually an interesting idea because it
does beg the question of how we maximize--when the capital
improvements list is so long on such limited resources. So, we
have these other resources happening that kind of work in their
own silo.
Chairman Sanders. Let me just jump in. I am sorry.
Senator Hirono, we are going to get to you in a second. I
appreciate your patience. [Laughter.]
Senator Begich. I know she cares about this issue too.
Chairman Sanders. Right. She is in a very rural State as
well.
Two questions, Senator Begich, number 1, if a veteran walks
into an Indian health service dental facility, will the VA pay
for that dental care?
Senator Begich. That is a great question. I do not know. It
depends I think on the care and the need and what they are
qualified for.
But the greatest thing I have to tell you, Mr. Chairman, is
the one in Fairbanks that just opened, the Tanana Chiefs
facility, well, I wish when I was growing up as a kid in Alaska
I had that kind of dental service. I mean, it is unbelievable
care. But what they provide you with is unique and why the VA--
we have to equalize these systems.
Chairman Sanders. The other point that I would make is one
of the things that we are looking at--Senator Johanns, you
would be interested in this as well--is we have many, many
hundreds, in addition to Indian health service clinics, we have
federally-qualified community health centers.
Senator Begich. Yes.
Chairman Sanders. And the same principle exists. I am a
veteran and there is an FQHC across the street but there is a
CBOC 50 miles away. Should I be able to go into the FQHC?
Senator Begich. Right.
Chairman Sanders. In talking to these service
organizations, I think there is a lot of support for that
concept. Some of the details have to be worked out, but I did
want to let you know we are working on that.
Senator Begich. Let me just end this by saying first, what
is unique about that system--at least the Newcomb model as we
call it in the Indian health services in Alaska and the new
emerging community health care systems--it is the newer model
of delivery systems.
So, when you walk in, how is your hearing, how is your
eyesight, how are your teeth----
Chairman Sanders. Holistic.
Senator Begich. Very holistic. And why is that important?
Because it cuts the cost of emergency care. I will give you one
last note: the native hospital in Alaska has cut their
emergency care recipients going in by 68 percent.
Chairman Sanders. That is an enormously important point. We
spend billions of dollars because people do not have access to
primary health care and they end up in the emergency room at 10
times the cost.
Senator Hirono, because you have been so patient you are
going to get extra time.
Senator Hirono. Well, thank you very much. I do not think I
will need 10 minutes but be that as it may.
Dr. Jesse, in your testimony I do not think that you gave
us your position or the VA's position on my bill relating to
the 24-month Catch-22 situation that new veterans face. So, I
hope that you will be supportive of this kind of a change
because they are in a situation over which we have no control.
Dr. Jesse. I am glad you spoke to it the way you did
because I do not think going in I fully understood that Catch-
22 piece that was in there. You know, I clearly was looking at
the issue of access to emergency care in general but that is a
real important point you bring up and we will bring that back.
Senator Hirono. The other thing is that Mr. Atizado of the
Disabled American Veterans, he will be in the second panel, but
he noted that while my bill addresses the new veteran, there is
still this 24-month requirement for all other veterans.
So, within a 24-month period, a veteran has to go and get
some kind of treatment at a veteran's facility. Otherwise, they
will not get reimbursed for emergency care.
So, my question is, what steps does the VA take to make
sure that veterans are aware of this 24-month requirement; and
second, are you aware of anything that prevents a veteran who
is already in the system, not a new veteran, from being able to
visit a VA facility within that 24-month period so that he or
she will be covered?
Dr. Jesse. So, there are a couple of things here that
address this. One is I do not think there is anything in the
way of anybody coming to a VA facility and getting literally
enrolled on the spot if that is the case and hence get
coverage.
It has been really since the post-9/11 ramping up, the very
clear direction from the Secretary that if somebody comes into
a VA facility and says that they are a veteran, they should get
care and we will figure out eligibility status later. I think
that is an important statement.
Then, the other piece of that is in part outreach, but this
was a component of the Secretary's transformation, T-21
transformation issue. But there is literally a handbook that
can be, it is being personalized to each veteran that we mail
to or they can actually get electronically. I think you can
pull it down now off of, the general version, not the
personalized version, off of Amazon or one of the booksellers.
But the notion as this was being developed is that when we
know the veterans, who they are, we can reach out to them and
say you are eligible for this care based on your service. This
is your nearest VA or your nearest clinic. This is who to call
to ask questions.
Senator Hirono. Well, apparently there is this 24-month
requirement; and if they miss that timeframe, they cannot be
reimbursed. So, my question is, are they reminded that you need
to have gone to a veterans' facility otherwise you are going to
lose this reimbursement benefit?
Dr. Jesse. That I do not know.
Senator Hirono. So, I think it has come up a number of
times, the lack of information and the need to provide
information, not just once because I am sure veterans get tons
of stuff that they are supposed to remember but, you know, who
can.
So, if they are going to be disallowed certain benefits
because of a timeframe, then we should figure out how they can
be timely reminded.
Dr. Jesse. We are actually terribly concerned about this in
particularly with the Guard and the Reserve who are not
connected through the DOD directly. We do now have a discharge
process, getting out of the military and going back into their
community, that literally takes a couple of days and all of
these issues are gone through with them. Then we reach back out
to veterans usually within 6 months to 1 year of there being
separated, again about their qualifications for VA.
So, it sounds like we might need to do a little bit of a
job there.
Senator Hirono. Yes, I think you get our concerns. It
cannot just be at the time of their discharge because these
things, they need to get timely reminders. It is like getting
your teeth cleaned every 6 months or so and you get your
notice.
I wanted to go to the Chairman's bill, S. 1581 which would
authorize treatment at VA facilities, not at regular non-VA
facilities, for military sexual assault victims; and these are
people who still are on active duty. My understanding is that
the VA system may have a process or they have counselors and
others who may not be in the regular systems.
So, would you support this kind of a change or this kind of
opportunity?
Dr. Jesse. In principle, the answer to that is absolutely
yes because we do it through the Vet Centers. So, there are 300
Vet Centers, 70 mobile; and they are authorized for active duty
people to use.
Authorization for active duty to use VA facilities for
certain things, I do not know if that creates a different set
of problems; but we are very attentive to the issue of military
sexual trauma. It is part of the screening process for every
clinic visit.
We screen for alcoholism. We screen for suicide. We screen
for military sexual trauma. So, it is an issue that is
important to us, that we are very much attuned to, and I just
do not know with enough certainty to say that if a military
person walked in, what the implication of treating for one
limited condition would be. But in the Vet Centers we do.
Senator Hirono. OK. I think the Chairman's bill is a good
bill and that these victims may, in fact, prefer to go to VA
where maybe they feel that there is more privacy, et cetera.
So, I think we should figure out a way that we can have this
happen and then whatever coordination of their records, et
cetera, that needs to occur should be something that we should
pursue.
Dr. Jesse. As I said, we did realize this as being an
important issue and the authority within the Vet Center system,
again which has a very broad footprint across the country, is
able to do.
Senator Hirono. OK. We shall continue.
Chairman Sanders. Thank you very much, Senator Hirono.
Senator Blumenthal.
Senator Blumenthal. Thank you again, Mr. Chairman, for
holding this hearing and thank you to each of the witnesses who
are here today for service to our veterans.
Let me begin, Dr. Jesse, and you can ask one of your
colleagues to answer, if necessary. As you know, I have focused
on the electronic records challenges and, in fact, have
sponsored the Servicemembers Electronic Health Records Act,
along with Senator Nelson to address what I see as the
unfortunate and unforgivable lag in the development of a truly
seamless, interoperable system with the Department of Defense.
Essentially, all this act really does is establish some
deadlines. Do you have a position on the bill? I hope that you
will support it.
Dr. Jesse. Sir, I do not think we have a formal agency
position. Every one of the points you bring up are important
and are a part of the complexity of working both in health IT
space, which by itself is a challenge, and also doing this
across Federal agencies.
You use the term interoperable. I think that data
interoperability is hugely important and I think is achievable.
Integrated so that everybody is using the same record creates a
different set of challenges but is probably, you know, built on
the foundation of data interoperability, data visibility, data
viewing is the first foundational step that needs to occur. I
think that is probably on a lot more solid grounds.
In terms of timelines, you know, to say a very general
statement, when you have timelines, things tend to happen
toward those timelines. When you do not, they tend to lag. They
tend, you know, to drift.
Senator Blumenthal. Well, I do not mean to make you the
target of my unhappiness----
Dr. Jesse. Thank you. Yes.
Senator Blumenthal [continuing]. Because I recognize that
this issue goes well beyond your job description or
jurisdiction.
But the answer that you have just given, ``that it is
achievable'' is the same answer that I have been given
literally since I arrived here which was 2-\1/2\ years ago. I
cannot accept that at this point in time the goal is achievable
but not achieved, and so I am asking you to commit on behalf of
your agency. I hope you will take this question back to General
Shinseki, either to commit that you will meet the deadlines in
the bill or to offer full support for the bill because if we
need to compel you to do it, in my view, we should do so giving
you the resources you need and giving the Department of Defense
the mandate that it apparently needs so that these goals are
not achievable but are it, in fact, achieved according to this
timeline which I think is realistic.
You know, I will just say to you, and I do not mean to be
condemnatory, but when people raise the issues of the
Affordable Care Act and some of the IT issues that have been
confronted there and say to me I have never seen this kind of
mess before. Well, the difficulty of making the DOD and VA
electronic records systems interoperable strikes me as very
much of the same ilk, very distinguishable. I recognized
technically maybe wholly unlike but in the view of laymen or
nonexperts like myself, the same question is why can we not get
it right.
Dr. Jesse. I appreciate the support, and we will take that
back in terms of our formal views; and if there is anything we
can do to provide you more information, we are happy to do
that.
Senator Blumenthal. I recognize also that it is not wholly
within your power. There is a potential partner here that has
to be incentivized or maybe compelled under law, the Department
of Defense, to do the right thing here. I know that there is a
history. So, I say all of the above with all due respect.
Let me ask you a final question. I know that you have seen
countless individuals like Justin Eldridge whom I have
described earlier who took his own life after a struggle with
Post Traumatic Stress.
I did not recount today but I did in my remarks this
morning on the floor that he actually knew he had a problem and
was told he had to wait before he could be given treatment.
That was some time ago.
His history is more complicated but the question is, are we
doing enough? Are we providing the care as rapidly as we need
to do?
I should have prefaced my statement by seconding the
remarks of some of my colleagues.
The VA hospitals do remarkable work. They help people in
extraordinary ways. I am a great admirer of what the VA has
done on issues of health care delivery to lead the way for our
Nation. So, this is not a hostile question. It is, again, more
a supportive one.
Dr. Jesse. So, first of all, any suicide is absolutely
tragic, and we do not just try to count numbers. We really try
to understand. People do not commit suicide because they want
to die. They commit suicide because they want the suffering to
stop. Often, we do not see where that suffering really lies.
Much of what we are doing toward that end now--we are very
good in the rescue of the potential suicide people who call the
crisis hotline. That organization does amazing things.
We need to be working much further back in the stream. How
are people suffering? You know, is it pain, is it PTSD, is it
other things? And get those resolved as quickly as possible
because that is how we support people.
Thank you.
Senator Blumenthal. Thank you. My time has expired but I
thank you very much.
Chairman Sanders. Senator Burr.
Senator Burr. Dr. Jesse, as it relates to the Alicia Dawn
Koehl Respect for National Cemeteries Act, understanding that
this is a unique case, what steps has VA taken to ensure that
this does not occur again.
Dr. Jesse. May I defer that?
Senator Burr. Sure.
Mr. McLenachen. Senator Burr, the VA does support the bill.
You know, it is unfortunate. You heard some testimony about how
long it took to resolve that issue. It was a complex legal
issue and I will defer to Mr. Hipolit about those.
But this is a very rare occurrence but the conclusion, the
legal conclusion that the General Counsel's Office reached was
that legislation was necessary to solve this problem in the
cases where it does arise.
Senator Burr. Let me ask you in reference to the future.
Would a question on the burial application asking whether the
veteran who is to be buried committed a capital crime or other
disqualifying offense be effective?
Mr. McLenachen. Well, it is my understanding--and again Mr.
Hipolit can correct me if I am wrong--but it is my
understanding those questions are asked currently when someone
appears to submit an application. In fact, the information we
have from the National Cemetery Administration is that there
were 107 yes answers to that question during the last fiscal
year.
Mr. Hipolit. I can amplify on that a little bit. Yes, there
is a question there. They do ask whether the veteran committed
a capital crime. A lot of times these things are taken in over
the phone or the funeral director or through the National
Cemetery Administration scheduling office. In many cases, the
funeral director may not know the information.
Senator Burr. So, the answer is obvious if they are
transferred from prison; but if they are not transferred from
prison, then that is sort of a potluck as to how it gets
answered?
Mr. Hipolit. Well, they do have that question. They do try
to find out the information. If there is any indication based
on the response that there may be an issue, like if they say
they do not know or whatever, then they do provide further
follow-up.
Senator Burr. Well, it is crucial that we get this bill
passed, and I think my colleagues understand that.
Dr. Jesse, I want to talk about the efforts for the VA
National Dialysis Center Program. I understand the VA is
opposed to my legislation because it would delay until mid-2015
the national roll out.
Now, why did VA decide to move forward with this expansion
in direct opposition to Congressional direction which you would
find in last year's MILCON/VA approps bill?
Dr. Jesse. So, I am a bit at a loss because I am not aware
that it is moving forward. We have got four pilots. I think----
Senator Burr. Well, let me stop you if I can because there
was in Sources Sought a notice released on October 9, 2013, on
FedBizOpps.com for National Dialysis Equipment Request by VA,
which, as I understand from my staff, the notice states, ``The
objective of this effort is to provide standardized
Hemodialysis Systems (also referred to as Dialysis Machines)
and associated Hemodialysis System Maintenance to facilitate
the stand-up of VA Dialysis Centers throughout the Nation.'' In
September, VA agreed to put the expansion on hold until January
after we tried to attach the dialysis bill.
But all of a sudden there is a solicitation out there with
a note that the VA intends to stand-up dialysis centers
throughout the Nation.
Dr. Jesse. So, I think the nuance here is a freestanding
dialysis center versus dialysis capabilities at VA facilities.
Now, I am not aware that the----
Senator Burr. Well, I am reading from what it said in the
note, ``* * * VA Dialysis Centers throughout the Nation.''
Dr. Jesse. Well, we provide dialysis throughout the Nation.
As I am saying, I am not aware of this. I will take that for
the record. But I am not aware that we have made any
solicitation to further expand free-standing dialysis centers.
Now, we are, as you know, trying to standardize----
Senator Burr. Well, there was an effort, there was an
effort to start to roll out the national VA system, right?
Dr. Jesse. Well, I think we agreed that we would do this
pilot.
Senator Burr. Well, let me ask you. What is the purpose of
a pilot?
Dr. Jesse. The purpose of this pilot is to understand: (A)
does it provide the level of access that we need; and I think
the largest issue in dialysis moving into the future is
capacity.
Senator Burr. Does the VA have a metrics that they look at?
Dr. Jesse. (B), is it cost effective.
Senator Burr. And have all the metrics been put together?
Dr. Jesse. Well, many of the metrics have been put
together. The initial location of the pilots was----
Senator Burr. Cleveland has only been open 3-\1/2\ months.
What could you learn or glean from Cleveland?
Dr. Jesse. At this point, what we can glean from Cleveland
is the complexities and costs of standing up the facility which
we have done for all the others. Cleveland was late in getting
up because of contracting issues, frankly.
Senator Burr. Have you learned enough from the 3-\1/2\ that
have stood up that this is a smart move, to nationally do for
the VA?
Dr. Jesse. Well, I do not think we have concluded that
analysis. I would defer the answer until we actually have. I
mean, it is appearing cost-effective. That may be a moving
target. The more the dialysis becomes--without meaning this in
a pejorative sense--becomes commoditized, and by that I mean we
have now dialysis centers that sit in strip malls--not VA, but
in this country--rather than being attached to health care
facilities or hospitals.
The real issue is people who need dialysis need it on a
frequent basis. The whole system may change if, in the next
year or 2 or 5 or 10, somebody comes up with a system to do
home dialysis in a much easier way.
Senator Burr. Would you be kind enough to share with the
Committee the metrics that were used to make a determination or
that you will make a determination to set up a national
structure of dialysis centers that are VA facilities?
And my last question would be this, did you not just this
past May sign a national plan for dialysis with the private
sector?
Dr. Jesse. We did I believe, yes. I did not personally but,
yes, we do have national contracts. There has been some
contention around the national contracts related to what VA was
paying versus relative to what CMS was paying, Medicare was
paying.
You know, our goal, our responsibility is to ensure that
veterans who need dialysis have access to the dialysis services
that they need but we do that for many different mechanisms.
Senator Burr. In fact, you signed a plan that you said will
only pay Medicare reimbursements. If the private sector chose
not to agree to that, which there is some question as to
whether that is----
Dr. Jesse. We are actually paying more than Medicare in
some areas, I think.
Senator Burr. In some areas. But were that not to be the
case, if they did not sign the contract, where would the
dialysis services be provided for veterans?
Dr. Jesse. Well, this is the challenge. Right?
Senator Burr. So, that plays a part in why the VA would
like to own their own infrastructure to do this; is so that
there is no competitive need in the marketplace, would you
agree?
Dr. Jesse. Well, so I am not sure I understand the
question. The VA probably does not drive the private sector.
Senator Burr. Well, you made the comment that one of the
things was that the original contract paid a price that was
higher than Medicare, and that was something that in the
negotiations was expressed to all private sector bidders.
Dr. Jesse. Uh-huh.
Senator Burr. And it strikes me as a little bit
disingenuous that there would be pilot programs, an effort to
set up a national structure that I am convinced, and I think
many Members of the Committee are that would not have stopped
had we not raise an issue.
All I am asking for is not to make the decision. I am
asking to look at the metrics which I have been unable to
access that make the cost and benefit analysis for VA doing
this in-house versus VA continuing to contract with private
services deliveries.
Dr. Jesse. Right. So, two things. First of all, absolutely
I think that is what we owe you and I think we have said that
we will do that before we move forward with a firm decision on
how we would roll this out.
I think the second issue is that the VA will never be able
to do all of its own dialysis in the current construct of what
dialysis entails. Our responsibility is to ensure that veterans
who need it can get it and particularly close to home. It makes
no sense for somebody to have to drive 3 hours to get dialysis,
and we would never have the capacity to do that.
When we originally looked at these pilots we looked at
where do we have areas where there were significant populations
of veterans who have renal failure, who get dialysis, in a
range that it would make sense based on the known capacity of a
dialysis unit to function effectively in these areas. They were
set up as pilots, again, to understand what it would take for
us to do this.
Senator Burr. The Chairman has been very kind.
Let me just say that I am not necessarily sold on the fact
that the VA can produce the benefit, can deliver the service
cheaper than the private sector has been able to deliver it but
I look forward to you helping me with that.
Dr. Jesse. Absolutely.
[The requested information was received and is being held
in Committee files.]
Chairman Sanders. OK. With that, let me thank the panel
very, very much for your excellent testimony.
Now, we have our second panel and we apologize to them for
running a little bit late.
Before I introduce our panelists, I would just like to
mention that Senator Burr and I are in agreement that we should
discharge in the Committee from further consideration the Bill
Young naming bill and hot line this bill this evening.
Anybody object to that?
If not, that is how we will proceed.
OK. I am delighted to welcome our next panel. We have
Adrian Atizado, who is the Assistant National Legislative
Director of the DAV. We have Colonel Bob Norton, who is the
Deputy Director of Government Relations for the Military
Officers Association of America. We have also with us Rick
Weidman, Executive Director for Policy and Government Affairs
for the Vietnam Veterans of America. We thank all three of you
very much for being here.
Mr. Atizado, we would like to begin with you.
STATEMENT OF ADRIAN ATIZADO, ASSISTANT NATIONAL LEGISLATIVE
DIRECTOR, DISABLED AMERICAN VETERANS
Mr. Atizado. Mr. Chairman, Ranking Member, and Member of
the Committee, on behalf of the Disabled American Veterans, I
am pleased to be here today to present our views on the bills
under consideration. For the sake of brevity I will only
highlight two bills out of those that are on today's agenda and
refer the Committee to our written testimony on our views for
the remaining bills.
The first bill is S. 1578. It is the Medical Foster Medical
Home Act of 2013. This bill will authorize VA to cover the
costs associated with the care of veterans at VA approved
medical foster homes.
So as this Committee is aware, the medical foster home may
be an appropriate setting for veterans who would otherwise be
placed in a nursing home care because they lacked a support
network to remain in their own homes.
DAV is please with VA's innovation of offering this program
as part of its long-term services and support. But while
patient participation in the program is voluntary, it does
yield very high satisfaction among veteran residents.
In addition because of its low cost, many VA facilities
perceive this program as a cost-effective alternative to
nursing home placement and it is gaining popularity based on
the expansion of this program over the last few years.
Because this program requires veterans in medical foster
home programs to pay for their care which ranges from about $50
to $150 a day, even veterans who are otherwise entitled to
nursing home care fully paid for or provided by VA must pay
their share of residence in a medical foster home. Thus,
service-connected veterans who do not have the resources to pay
for their portion are unable to avail themselves of this very
important benefit.
So, based on our resolution that supports legislation to
expand a comprehensive program of long-term services and
supports for service-connected veterans, we are, in fact, very
pleased to support the intent of this bill.
We would like, however, to bring the Committee's attention
to the current statutory authority which limits the VA from
meeting its obligation to provide home and community-based
long-term services and supports to service-connected disabled
veterans such as this medical foster home program that we are
discussing today.
Because of this limitation in current statutory authority,
we believe the intent of this legislation should actually be
codified or amend current statutory authority.
The second bill is S. 1584, which would allow qualified
disabled veterans the opportunity to utilize the automobile
grant program up to three times rather than the current
allowance of once and increase the current amount from $18,900
to $30,000.
Not only has the issue of increasing the amount of
automobile grant benefits has been a long-standing issue for
DAV other veterans service organizations have also sought to
have the amount of this vital benefit increased.
Collectively, we have urged Congress to extend the
automobile grant benefit by allowing previous recipients of a
much lesser amount--in years past it ranged from anywhere from
11 to 8000, even less--for those veterans to be able to receive
a supplemental auto grant for the difference between their
original grant and the current grant, if it was higher.
Last year, the Department of Transportation reported the
average life span of a vehicle, general vehicle, was 12 years
or just under 129,000 miles.
The cost of replacing a modified vehicle can range anywhere
from $40- to $65,000 for a new vehicle and $21- to $35,000
used. This is on average. Now, these tremendous costs,
compounded by inflation, present a financial hardship for many
severely disabled veterans who need to replace their primary
mode of transportation once it exceeds its expected life.
As such, in accordance with our resolution, we support an
enactment of this bill as it will expand the vital automobile
grant benefits by allowing multiple uses while increasing the
current amount, I should say the aggregate amount, to $30,000.
Mr. Chairman, this concludes my testimony. As always, the
DAV looks forward to working with the Committee as well as the
bills of sponsors' staff on any concerns that we have on their
bills. I would be happy to answer any questions you or other
Committee Members may have.
[The prepared statement of Mr. Atizado follows:]
Prepared Statement of Adrian M. Atizado, Assistant National
Legislative Director, DAV
Chairman Sanders, Ranking Member Burr and Members of the Committee:
Thank you for inviting the DAV (Disabled American Veterans) to testify
at this legislative hearing of the Senate Veterans' Affairs Committee.
As you know, DAV is a non-profit veterans service organization
comprised of 1.2 million wartime service-disabled veterans dedicated to
a single purpose: empowering veterans to lead high-quality lives with
respect and dignity. DAV is pleased to be here today to present our
views on the bills under consideration by the Committee.
s. 875, the department of veterans affairs disease reporting and
oversight act,
and
draft bill, to require the secretary of veterans affairs to ensure the
department of veterans affairs has an up-to date policy on reporting of
cases of infectious diseases, to require an independent assessment of
the organizational structure of the veterans integrated service
networks and department medical centers.
These measures seek to strengthen Department of Veterans Affairs
(VA) policy in reporting nationally notifiable diseases published by
the Council of State and Territorial Epidemiologists and the Centers
for Disease Control and Prevention (CDC), or those infectious diseases
required by a provision of law of a state.
Timely disease surveillance, identifying disease outbreaks, and
recognizing disease trends in a community is critical to preventing
infectious disease morbidity and mortality. Incomplete reporting, lack
of consistent national standards, and a lack of timely reporting have
created significant barriers to appropriate and effective disease-
specific control measures since delays between the onset of illness and
receipt of disease notification can allow for additional transmission
to occur and additional people to become ill, thereby facilitating
further spread of infection.
DAV believes the intent of these bills is laudable; lacking a
national standard however, we urge the Committee ensure VA, CDC and
Council of State and Territorial Epidemiologists work collaboratively
to ensure the resulting VA policy address any barriers or ambiguities
for timely and effective disease surveillance without placing undue
burden on the Department and local VA facilities. Further,
consideration of these measures and subsequent VA policy should be
balanced with the requirements of sections 5701 and 7332 of title 38,
United States Code, that protects the confidentiality of veterans
health and personally identifiable information.
s. 1148, the veterans benefits claims faster filing act
S. 1148 would direct the Secretary of Veterans Affairs to provide
notice of average times for processing claims and percentage of claims
approved. The goal of the legislation is to encourage veterans to seek
the assistance of veterans service organizations (VSOs) and file claims
for VA benefits using the Fully Developed Claim (FDC) process.
This legislation would make available to all current and potential
veteran claimants information regarding the success or allowance rate
of claims in each Department of Veterans Affairs (VA) Regional Office
(RO) by requiring the Secretary of Veterans Affairs to publish this
information on VA's Web site. Additionally, this information will be
required to be conspicuously posted in every VARO and, when a claim is
received, VA will notify the claimant of such information, including
information about the benefit of filing a FDC, such as faster
processing time and eligibility to receive up to an extra year of
benefit payments.
The type of information this legislation is seeking to publicize to
every claimant is the average processing time of claims and the
percentage of allowed or granted claims for those with representation
versus those without representation. Additionally, S. 1148 will require
the information to be broken down into the percentage of claims that
were FDC submitted electronically versus paper as compared to those who
do not file their claims through the FDC program in electronic,
standard paper or non-standard paper form.
DAV supports the principle of S. 1148, which is to bring better
awareness and information to a claimant prior to filing a claim for
benefits in the same manner as its companion bill, H.R. 1809, which was
passed by the House. Both S. 1148 and H.R. 1809 are directed at
providing more in-depth information to a claimant about representation
in keeping with the primary goal of encouraging claimants to submit
their claims for benefits through the FDC program.
DAV agrees with encouraging claimants to submit their claims
through the FDC process, as is a standard practice for DAV.
Nonetheless, DAV believes, in order to fully reach the goal of this
legislation and, more importantly, to benefit the claimant in the best
way possible, the posted information should provide a breakdown of the
number of claims represented and the allowance rate for each VSO and
for representatives other than VSOs. Otherwise, this information may
not allow an individual to make an informed decision about
representation. Moreover, when publishing this type of information, it
should include the fact that DAV and other VSOs provide representation
to virtually any claimant in the process, with the exception of
frivolous or fraudulent claims. Conversely, others providing
representation, including attorneys, tend to be much more selective in
their representation; often choosing to represent only claims wherein
the predicted outcome is favorable to the claimant. DAV believes this
should also be made clear to a claimant in the published information.
While we do not have a specific resolution to support this matter,
DAV does support the intent of S. 1148, which will require VA to make
this information available to claimants; however, we are concerned
about the possibility that this legislation, if enacted, may burden the
VA at a time when their primary focus is directed at reducing the
backlog of disability claims and transforming the claims process.
s. 1155, the rural veterans mental health care improvement act
S. 1155, if enacted, would achieve four basic purposes. First, it
would amend current law governing advance appropriations in VA health
care by adding appropriations accounts and sub-accounts that provide
funding for information technology (IT). Second, it would add two
professional fields (marriage and family therapists, and mental health
counselors) to existing career health fields that are participating in
VA's academic health education programs, and would require the VA
Secretary to apportion funding, from funds available, to these new
professions. Third, the bill would require amendments to current
authority for readjustment counseling and mental health counseling for
family members of certain veterans; and, fourth, the bill would require
VA to submit a report to Congress on telemedicine.
Based on DAV Resolution No. 180, DAV strongly supports Congress
extending advance appropriations to all VA discretionary appropriations
accounts. We believe the VA health care system's experience over the
past three years, and particularly this year, protected by advance
appropriations while most of the remainder of the Federal Government
was forced to deal with continuing appropriations (and now a shutdown),
produces a strong justification for protecting all of VA's
discretionary accounts. While we support the provision in this bill
that would bring IT accounts under the protection of advance
appropriation, we ask the Committee rather to consider enacting S. 932,
the Putting Veterans Funding First Act of 2013.
DAV has not received a specific resolution from our membership
addressing the need to add the two new career fields of marriage and
family therapists and mental health counselors to VA's academic
responsibilities. VA already possesses authority to employ such
providers, either in direct health care or in Readjustment Counseling
Vet Centers. Absent a showing of shortage of available practitioners in
these professions, mandating their inclusion within VA's responsibility
in conducting its health care training programs may be ill advised. We
defer to VA on balancing its academic programs across health
professionals career fields and suggest the same to the bill's sponsor.
On the strength of resolutions from our membership we strongly
support the existing VA family caregiver support program and VA's
independent Vet Center readjustment counseling program; therefore, we
support these provisions in this bill that would clarify and expand
these efforts.
We have no objection to the report on telemedicine that the bill
would require.
s. 1165, the access to appropriate immunizations for veterans act of
2013
This measure would require the Secretary of Veterans Affairs to
make available periodic immunizations against certain infectious
diseases as adjudged necessary by the Secretary of Health and Human
Services through the recommended adult immunization schedule
established by the Advisory Committee on Immunization Practices. The
bill would include such immunizations within the authorized
preventative health services available for VA-enrolled veterans. The
bill would establish publicly reported performance and quality measures
consistent with the required program of immunizations authorized by the
bill. The bill would require annual reports to Congress by the
Secretary confirming the existence, compliance and performance of the
immunization program authorized by the bill.
DAV Resolution No. 036 calls on VA to maintain a comprehensive,
high-quality, and fully funded health care system for the Nation's sick
and disabled veterans, specifically including preventative health
services. Preventative health services are an important component of
the maintenance of general health, especially in elderly and disabled
populations with compromised immune systems. If carried out
sufficiently, the intent of this bill could also contribute to
significant cost avoidance in health care by reducing the spread of
infectious diseases and obviating the need for health interventions in
acute illnesses of those without such immunizations.
While DAV is pleased to support this bill, we urge the Committee to
work with VA to address concerns the Department has raised with similar
legislation. Those concerns included requiring that the quality metric,
including targets for compliance, be established via notice and comment
rulemaking would limit VA's ability to respond quickly to new research
or medical findings regarding a vaccine. Moreover, because the clinical
indications and population size for vaccines vary by vaccine, blanket
monitoring of performance of all vaccines could be cost prohibitive and
may not have a substantial positive clinical impact at the patient
level.
s. 1211, to prohibit the use of the phrases gi bill and post-9/11 gi
bill to give a false impression of approval or endorsement by the va
S. 1211 would amend title 38, United States Code, to prohibit the
use of the phrases GI Bill and Post-9/11 GI Bill to give a false
impression of approval or endorsement by the VA.
DAV does not have a resolution on this issue and takes no official
position.
s. 1216, the improving job opportunities for veterans act of 2013
S. 1216 would improve and increase the availability of on-job
training and apprenticeship programs carried out by the Secretary of
Veterans Affairs.
In accordance with DAV Resolution No. 001, DAV supports this
legislation.
s. 1262, the veterans conservation corps act of 2013
S. 1262 would require the Secretary of Veterans Affairs to
establish a veterans conservation corps.
DAV does not have a resolution on this issue and takes no official
position on this legislation.
s. 1281, the veterans and servicemembers employment rights and
housing act of 2013
S. 1281 would prohibit employment practices that discriminate based
on an individual's military service and amends the Fair Housing Act and
the Civil Rights Act of 1968 to prohibit housing discrimination against
members of the uniformed services.
DAV does not have a resolution on this issue and takes no official
position on this bill.
s. 1295, to require the secretary of veterans affairs to provide
veterans with notice, when veterans electronically file claims for
benefits under laws administered by the secretary, that relevant
services may be available from veterans service organizations
S. 1295 would amend title 38, United States Code, to require the
Secretary of Veterans Affairs to provide veterans with notice, when
veterans electronically file claims for benefits under laws
administered by the Secretary, that relevant services may be available
from veterans service organizations.
While DAV does not have a specific resolution on this issue we
support the intent of the legislation to make claimants fully aware of
the vast, free services and assistance that are available from veterans
service organizations. Navigating the VA system and the plethora of
benefits available can be very complicated and paralyzing to any
claimant and we appreciate the goal of S. 1295 to help ease this
burden.
s. 1296, the servicemember's electronic health records act of 2013
This measure would amend Section 1635 ``Wounded Warrior'' and
veterans provisions in the fiscal year 2008 National Defense
Authorization Act (NDAA), to create a specific timeline and deadlines
for a joint electronic health record to be implemented. This timeline
would require, among other things, the Department of Defense (DOD) and
VA to agree on and create standardized forms for data capture within
180 days of enactment. They would have one year to attain seamless
integration and sharing of information and data downloading using the
Blue Button Initiative.
The bill also would require the agencies to consider storage of
patient data in a secure, remote, network-accessible computer storage
system or a cloud storage system. This type of storage system would
allow servicemembers and veterans to upload their own information and
allow their providers to have the ability to see the records at any
time. The cloud storage system would increase interoperability and
allow the patient to more easily share their information with their
medical provider.
The development of an integrated DOD/VA electronic health record
(EHR) has been beset with problems for years. Efforts to create a joint
DOD/VA EHR scheduled to become operational in 2017 came to a halt in
February 2013. The new plan includes both Departments to pursue
separate systems and gain interoperability using existing commercial
software.
The plan also assumes that in the summer of 2013, both Departments
were to have launched pilot programs on the common interface at seven
joint rehabilitation centers nationwide, initially, and eventually to
nine sites, overall. All of the facilities were scheduled to exchange
data that is computable and interoperable by the end of July.
Criticism of this decision resulted in an amendment to the House
passed 2014 NDAA to increase oversight of the integrated electronic
health record (iEHR). Notably, Section 734 of the National Defense
Authorization Act of 2014 would require DOD and VA to give appropriate
congressional committees a plan on an iEHR by January 31, 2014. This
plan would include program objectives, organization, responsibilities
of the departments, technical system requirements, milestones
(including a schedule for industry competitions), system standards the
program will use, metrics to assess the program's effectiveness, and
funding levels needed for fiscal years 2014 to 2017 in order to execute
the plan. It would also limit funding for development of an iEHR until
the Government Accountability Office confirms the proposed system to be
deployed by October 1, 2016, meets stated requirements.
We note that despite strong and consistent Congressional mandates
and oversight over those years, efforts by both Departments remain
fragmented and have proceeded at a glacial pace. As part of The
Independent Budget, DAV remains firm that the DOD and VA must complete
an electronic medical record process that is fully computable,
interoperable, and that allows for two-way, real-time electronic
exchange of health information and occupational and environmental
exposure data for transitioning veterans. Effective record exchange
could increase health care sharing between agencies and providers,
laboratories, pharmacies, and patients; help patients transition
between health care settings; reduce duplicative and unnecessary
testing; improve patient safety by reducing medical errors; and
increase our understanding of the clinical, safety, quality, financial,
and organizational value of health IT.
DAV believes the intent of S. 1296 is laudable; however, we ask the
Committee ensure the measure is consistent with the pertinent
provisions in the 2014 NDAA awaiting consideration by the Senate.
Moreover, we urge the Committee to consider the current capabilities of
the Interagency Program Office (IPO), which would likely be responsible
for meeting the requirements contained in S. 1296. The IPO was
established by Congress in Section 1635 of Public Law 110-181, the 2008
National Defense Authorization Act as the office accountable for
developing and implementing the health information sharing capabilities
for DOD and VA. Staffing challenges within the IPO have been an issue.
As of January 2013, the IPO was staffed at about 62 percent of the 236
employees assigned by both departments, according to a February 2013
Government Accountability Office report, which also noted hiring
additional staff is one of the biggest challenges.\1\
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\1\ Long History of Management Challenges Raises Concerns about
VA's and DOD's New Approach to Sharing Health Information, Government
Accountability Office, February 27, 2013. Washington, DC.
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s. 1361, the world war ii merchant mariner service act
S. 1361 would direct the Secretary of Homeland Security to accept
additional documentation when considering the application for veteran
status of an individual who performed service as a coastwise merchant
seaman during World War II.
DAV does not have a resolution on this issue and takes no position
on S. 1361.
s. 1399, to extend the interest rate limitation on debt entered into
during military service to debt incurred during military service to
consolidate or refinance students loans incurred before military
service
S. 1399 would amend the Servicemembers Civil Relief Act to extend
the interest rate limitation on debt entered into during military
service to debt incurred during military service to consolidate or
refinance students loans incurred before military service.
DAV does not have a resolution on this issue and takes no official
position on this legislation.
s. 1411, the rural veterans health care improvement act of 2013
S. 1411 would require the Office of Rural Health of the Veterans
Health Administration to update its ``Strategic Plan Refresh,'' a
document VA issued in 2012 that reviewed VA's rural health
expenditures, and laid out VA's plans for rural health developments
over the near term, and for other purposes. Our members have approved
DAV Resolution No. 211, calling on Congress and VA to support
sufficient resources for VA to improve health care services for
veterans living in rural or remote areas; thus, we support this bill.
s. 1434, to rename the junction city, kansas community-based outpatient
clinic
S. 1434 would designate the Junction City Community-Based
Outpatient Clinic located at 715 Southwind Drive, Junction City,
Kansas, as the Lieutenant General Richard J. Seitz Community-Based
Outpatient Clinic.
As a local issue, DAV does not have a national position on the
matter.
s. 1471, the alicia dawn koehl respect for national cemeteries act
S. 1471 would authorize the Secretary of Veterans Affairs and the
Secretary of the Army to reconsider decisions to inter or honor the
memory of a person in a national cemetery.
DAV does not have a resolution on this issue and takes no official
position on this bill.
s. 1540, to remove a legal obstacle that effectively prevents state
veterans homes from applying for federal grants to support homeless
veterans programs
S. 1540 was introduced in order remove a legal obstacle that
effectively prevents state veterans homes from applying for Federal
grants to support a homeless veterans program.
State veterans homes are a partnership between the Federal
Government and the States, with the Federal Government providing
construction grants that may cover up to 65 percent of the cost to
build and maintain the homes, and states providing the balance. In
addition, the Federal Government pays a per diem covering approximately
one-third of the cost to care for qualified veterans under three
authorized programs: nursing home care, domiciliary care and adult day
health care.
Currently, some state veterans homes have underutilized bed
capacity in their domiciliary program, a portion of which could be
repurposed for homeless veterans programs. A few state homes that are
well positioned to provide and coordinate the multitude of health care
and supportive services required by homeless veterans have expressed an
interest in applying for grants operate such a program. However under
current law, state homes are authorized to use their Federal support
only for the three aforementioned programs and if a state home were to
operate a homeless veterans program, the Federal Government could seek
to recapture construction grant funding provided over the prior twenty
years. Since no state home could afford to pay that high a financial
penalty, this provision effectively prevents them from using excess
capacity for operating a homeless veterans program.
S. 1540 seeks to resolve this problem by amending the recapture
provisions of title 38, United States Code, section 8136, with an
exemption for state homes that receive a contract or grant from VA for
residential care programs, including homeless veterans programs. The
change would remove the financial obstacle preventing some state homes
from applying for Federal grants to support homeless veterans, such as
through VA's Health Care for Homeless Veterans program, but the
decision to award the grant (or contract) would remain solely with VA
as the grantor. It would be up to VA to determine whether the state
home had sufficient excess capacity and was capable of operating a
successful homeless veterans program.
By allowing state homes with excess bed capacity in their
domiciliary programs to repurpose a portion of that existing space to
support homeless veterans, this legislation would allow some additional
options for homeless veterans in a cost-effective manner.
In line with DAV Resolution No. 165, which calls for sustained
sufficient funding to improve services for homeless veterans, DAV
supports the intent of this legislation; however, we urge the Committee
ensure the legislation allows for the recapture of the portion of
grants to state homes if so provided for the costs of construction,
renovation, or acquisition of a building for use as service centers or
transitional housing for homeless veterans under VA's Homeless
Providers Grant and Per Diem Program.
s. 1547, the veterans dialysis pilot program review act of 2013
VA estimates show that in FY 2011, approximately 35,000 veterans
enrolled in the VA health care system were diagnosed with end-stage
renal disease (ESRD) reflecting a higher prevalence in the VA
population than in the general U.S. population.\2\ Initiated based on
the rapidly rising cost of VA paid hemodialysis treatment in non-VA
facilities and the high rates of morbidity and mortality of veteran
patients with ESRD, several VA studies of this veteran patient
population and paid for or directly provided dialysis therapy have been
conducted.\3\
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\2\ Comparison of outcomes for veterans receiving dialysis care
from VA and non-VA providers, Wang et al., BMC Health Services Research
2013, 13:26.
\3\ Comparing VA and private sector healthcare costs for end-stage
renal disease, Hynes et al., Medical care 2012, 50(2):161-170.
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The May 23, 2012 Government Accountability Office (GAO) report on
VA's Dialysis Pilot states VA had not fully developed performance
measures for assessing the pilot locations \4\ even though the
Department has already begun planning for the expansion of the dialysis
pilot. Further, GAO indicated that such an expansion ``should not occur
until after VA has defined clear performance measures for the existing
pilot locations and evaluated their success.''
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\4\ Veterans Affairs (VA) medical centers (VAMC) in Durham and
Fayetteville, North Carolina started June 2011; Philadelphia,
Pennsylvania started October 2012; and Cleveland, Ohio started
July 2013.
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This measure would limit the expansion of VA's dialysis pilot
program beyond current locations, require an independent analysis of
the pilot, and to submit a report to Congress based on the analysis.
While Congress has been focused on VA's actions to address the
growing demand of dialysis therapies depicted in recent committee
reports,\5\ DAV is concerned that the discussion on VA's dialysis pilot
and on the Department's purchased or provided dialysis therapy in
general appears to be centered on cost and we find there is not
sufficient emphasis on the veteran patient.
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\5\ House Appropriations Report 112-094 page 41, May 213, 2011 and
House Appropriations Reports 112-491, pages 39-40, May 23, 2012.
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Certainly, ESRD patients are one of the most resource-intensive
patient populations in the VA health care system. However, the burden
of hemodialysis is extreme to veteran patients. It is a life-altering
event that has implications for the veteran's health, lifestyle, and
livelihood. Veterans diagnosed with ESRD are often prescribed and must
receive dialysis treatments. These treatments are time intensive for
veterans and typically require three outpatient treatments per week
that each last about 4 hours for the rest of their lives unless they
receive a kidney transplant.
As one of The Independent Budget veterans service organizations
(IBVSOs), coordinating care among the veteran, dialysis clinic, VA
nephrologists, and VA facilities and physicians is essential to
improving clinical outcomes and reducing the total costs of care. The
benefits of an integrated, collaborative approach for this population
have been proven in several Centers for Medicare and Medicaid Services
demonstration projects and within private-sector programs sponsored by
health plans and the dialysis community. Such programs implement
specific interventions that are known to avoid unnecessary
hospitalizations, which frequently cost more than the total cost of
dialysis treatments. These interventions also focus on behavioral
modification and motivational techniques. The potential return on
investment in better clinical outcomes, higher quality of life, and
lower costs could be substantial for VA and veteran patients.
We understand that some community dialysis providers are piloting
the integrated care management concept among their veteran population.
The IBVSOs believe that VA should provide integrated care management in
this pilot program that can test and demonstrate the value of such an
approach to VA and the veterans it serves.
s. 1556, to modify authorities relating to the collective bargaining of
employees in the vha
S. 1556 would amend title 38, United States Code, to modify
authorities relating to the collective bargaining of employees in the
Veterans Health Administration.
This bill would restore some bargaining rights for clinical care
employees of the VHA that were eroded by the former Administration and
through subsequent Federal court decisions. The bill would strike
subsections (b), (c) and (d) of section 7422 of title 38, United States
Code. Enactment of the bill would have the effect of authorizing
employee representatives of recognized bargaining units to negotiate
with VHA management over matters of employee compensation and
conditions of employment other than their rates of basic pay. This
feature is an important one in that locality pay elements and
performance pay increments are subject only to VA's internal
policymaking determinations. Recognized VA employee representatives
have been subjectively excluded from participating in these decisions
based on VA's interpretation that section 7422 broadly blocks any
negotiation due to its potential negative impact on the quality of care
of veterans.
We believe labor organizations that represent employees in
recognized bargaining units within the VA health care system, including
in its professional units, have an innate right to information and
reasonable participation that result in making the VA health care
system a workplace of choice, and in particular, to fully represent VA
employees on issues impacting their conditions of employment.
Congress passed section 7422, title 38, United States Code, in
1991, in order to grant specific bargaining rights to labor in VA
professional units, and to promote effective interactions and
negotiation between VA management, and its labor force recognized
representatives concerned about the status and working conditions of VA
physicians, nurses and other direct caregivers appointed under title
38, United States Code. In providing this authority, Congress granted
to VA employees and their recognized representatives a right that
already existed for all other Federal employees appointed under title
5, United States Code. Nevertheless, Federal labor organizations have
reported that VA severely restricts the recognized Federal bargaining
unit representatives from participating in, or even being informed
about, a number of human resources decisions and policies that directly
impact conditions of employment of the VA professional staffs within
these bargaining units. We are advised by labor organizations that when
management actions are challenged, VA officials (many at the local
level) have used subsections (b), (c) and (d) of section 7422 as a
statutory shield to obstruct any labor involvement to correct or
ameliorate the negative impact of VA's management decisions on
employees, even when management is allegedly not complying with clear
statutory mandates (e.g., locality pay surveys and alternative work
schedules for registered nurses, physician locality pay compensation
panels, etc.).
We believe this bill, which would rescind VA's ability to refuse to
bargain on matters of employment conditions and elements of
compensation other than rates of basic pay embedded in law, is an
appropriate remedy to address part of the bargaining problem in the
VA's professional ranks. We understand recently VA has given Federal
labor organizations some indication of additional flexibility in
negotiating labor-management issues such as some features of
supplemental compensation, and we are hopeful that this change signals
a new trend in these key relationships that directly affect sick and
disabled veterans.
While DAV has not received a specific resolution from our
membership related to the issues contained in this bill, we would not
object to its enactment, while continuing to hope that VA and Federal
labor organizations can find a sustained basis for compromise.
s. 1558, to carry out a program of outreach for veterans to increase
their access and use of federal, state, and local programs providing
compensation for service in the armed forces
S. 1558 would require the Secretary of Veterans Affairs to carry
out a program of outreach for veterans to increase their access and use
of Federal, State, and local programs providing compensation for
service in the Armed Forces and the awareness of such programs by
veterans and their eligibility for such programs.
Although DAV does not have a resolution on this particular matter,
we currently provide such outreach to veterans and, therefore, we would
not oppose passage of this legislation. The intent of this bill is to
make veterans aware of the services and benefits from the VA that they
have earned, which will increase the use of VA benefits and services.
While we certainly agree and support the increased awareness, this will
undoubtedly lead to increased demands placed upon the VA. Congress must
ensure that VA has the adequate resources to handle the increase in
demand.
If the enhanced outreach is successful and the demand too great,
then this endeavor would cause a negative impact on VA and the veterans
it serves.
s. 1559, the benefits fairness for filipino veterans act of 2013
S. 1559 would amend title 38, United States Code, to modify the
method of determining whether Filipino veterans are United States
residents for purposes of eligibility for receipt of the full-dollar
rate of compensation under the laws administered by the Secretary of
Veterans Affairs.
DAV does not have a resolution on this issue and takes no position
on S. 1559.
s. 1573, the military family relief act
S. 1573 would amend section 1318 of title 38, United States Code,
to provide for the payment of temporary compensation to a surviving
spouse of a veteran upon the death of the veteran. Essentially this
legislation is aimed at providing temporary death benefits to a
surviving spouse for six months, without regard to whether that
individual has submitted a claim for such compensation if, at the time
of the veteran's death the veteran was in receipt or entitled to
receive compensation for a service-connected disability continuously
rated as total for not less than one year immediately preceding the
veteran's death.
Specifically, if enacted, S. 1573 would allow a surviving spouse to
receive payment of survivors benefits temporarily, for six months, with
no lapse in time from the discontinuance of disability compensation
upon the veteran's death. Given the current backlog of pending claims
within the Veterans Benefits Administration (VBA), surviving spouses
are left for months upon months with no income between the time of the
veterans' death (and resultant loss of disability compensation) and the
time dependency and indemnity compensation (DIC) benefits are awarded.
Under section 1318 of title 38, United States Code, certain
surviving spouses may be entitled to DIC if at the time of the
veteran's death, the veteran was continuously rated totally disabled
for a period of five years within discharge or release from active
duty; the veteran was continuously rated totally disabled for a period
of 10 years or more; or the veteran was contiuously rated totally
disabled for a period of one year if the veteran was a former prisoner
of war.
Generally, claims submitted for DIC that meet any of the
aforementioned eligibility criteria can be processed by VBA very
quickly because little to no development is required. However, because
of the dire backlog of claims within VBA, qualified surviving spouses
are left to languish for unacceptably long periods of time with no
income. Even if the surviving spouse were to file a qualifying claim
for DIC pursuant to Section 1318 of title 38, United States Code, under
the more expedient FDC process, a lapse in payment and loss of vital
income would still exist. S. 1573 is directed specifically at bridging
the gap of benefits between the veteran's death and the time DIC is
awarded. While this measure would provide DIC only temporarily for six
months, it would ease the burden the veteran's death and immediate loss
of vital income while VBA finally processes the claim.
In accordance with DAV Resolution No. 001, DAV supports enactment
of S. 1573.
draft bill, to update the service disabled insurance program to base
premium rates on the commissioner's 2001 standard ordinary mortality
table instead of the commissioner's 1941 standard ordinary table of
mortality
This bill would amend title 38, United States Code, to update the
Service Disabled Insurance program to base premium rates on the
Commissioner's 2001 Standard Ordinary Mortality table instead of the
Commissioner's 1941 Standard Ordinary Table of Mortality. DAV is
pleased to see the introduction of this draft Senate bill.
It is strongly supported by our organization and has been adopted
for decades as a formal resolution by DAV delegates. Also, the IBVSOs
have encouraged Congress to adjust these premium rates rather than
continue the practice of using an antiquated formula that has been
disproportionate to industry standards. This premium inequity has
persisted amongst disabled veterans for so many years with the monthly
cost of this insurance negating the overall value of the benefit
itself.
DAV strongly encourages this Committee to work with your colleagues
and with the House of Representatives to ensure favorable consideration
of this legislation. DAV also welcomes the opportunity to work with
Congress to ensure the enactment of this measure, which will have a
lasting and positive impact on our Nation's disabled veterans and their
families now and into the future.
draft bill, to provide replacement automobiles for certain disabled
veterans and members of the armed forces
This bill would amend title 38, United States Code, to provide
replacement automobiles for certain disabled veterans and members of
the Armed Forces. This measure, if enacted, would amend section 3903
allowing qualified disabled veterans the opportunity to utilize this
vital program up to three times, rather than the currently allowed one
time, and increase the current amount from $18,900 to $30,000. This
measure will allow a qualified disabled veteran the ability to use the
benefit up to two times beyond the initial use of the grant with an
aggregate amount of $30,000 available to the veteran.
Not only has the issue of increasing the amount of the automobile
grant benefit been a long-standing issue for DAV, other veterans
service organizations (VSOs) have also sought to have the amount of
this vital benefit increased. DAV, joined with the other IBVSOs, have
urged Congress to expand the automobile grant benefit by allowing
previous recipients of a much lesser amount of $11,000, $8,000 or even
less, to be able to receive a supplemental auto grant for the
difference between what the original automobile grant and the current
amount.
For example, the VA provides financial assistance in the form of
grants to eligible veterans toward the purchase of a new or used
automobile to accommodate a veteran or servicemember with certain
disabilities that resulted from a disabling condition incurred or
aggravated during active military service. In December 2011, this one-
time auto grant was increased from $11,000 to $18,900, thus giving
service-disabled veterans who need a modified vehicle increased
purchasing power. While there are veterans who have not yet used the
grant, veterans who have exhausted the grant are left to replace
modified vehicles, once those vehicles have surpassed their useful
life, at their own expense and at a higher cost than the first adapted
vehicle due to inflation.
Additionally, last year the Department of Transportation reported
the average life span of a vehicle is 12 years, or about 128,500 miles.
The cost to replace modified vehicles can range from $40,000 to $65,000
new, and $21,000 to $35,000 used, on average. These tremendous costs,
compounded by inflation, present a financial hardship for many service-
disabled veterans who need to replace their primary mode of
transportation once it exceeds its expected life.
As such, in accordance with DAV resolution No. 170, DAV supports
enactment of this draft legislation as it will expand the vital
automobile grant benefit by allowing multiple uses while increasing the
current amount from $18,900 to an aggregate amount of $30,000.
draft bill, the veterans health care eligibility expansion act of 2013
Section 2 of this measure would amend title 38, United States Code,
section 1710 authorizing VA to provide health care to all veterans not
currently enrolled in the VA health care system provided they meet
other statutory requirements, including section 5303, availability of
appropriations, agreeing to pay copayments, etc.
In amending section 1710 however, this new authority would require
VA provide nursing home care to veterans described under the new
paragraph (3) of subsection (a) while giving VA the discretion to
provide nursing home care to veterans described under paragraph (2) of
subsection (a).
(2) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services, and may furnish nursing
home care, which the Secretary determines to be needed to any
veteran----
(3) In the case of a veteran who is not described in
paragraphs (1) and (2), the Secretary shall subject to the
provisions of subsections (f) and (g), furnish hospital care,
medical services, and nursing home care which the Secretary
determines to be needed. [Emphasis added]
DAV National Resolution No. 186 supports top priority access for
service-connected veterans within the VA health care system.
For purposes of equity, we recommend language amending paragraph
(2) to state that the Secretary shall furnish hospital care, medical
services, and nursing home care that the Secretary determines to be
needed to any veteran under subparagraphs A through G.
Section 3 would amend title 38, United States Code, section 1705
requiring VA allow for the enrollment by December 31, 2014, of
noncompensable service-connected veterans and nonservice-connected
veterans not currently permitted to enroll in the VA health care system
and who do not have access to health insurance except through state-
based health insurance exchanges established according to the Patient
Protection and Affordable Care Act.
DAV has no resolution to support this section and would not object
to its favorable consideration as long as sufficient resources are in
place at the time this enrollment takes effect.
Section 4 seeks to extend the eligibility for enrollment in the VA
health care system from 5 to 10 years following discharge for a combat
veteran discharged after January 27, 2003.
DAV has no specific resolution but the provision appears
beneficial, thus we would not oppose favorable consideration of this
section.
Section 5 intends to relocate section 1710(a)(4), which this
measure proposes to eliminate, and by adding a new subsection (c) in
section 1707.
DAV has no resolution and would not object to its favorable
consideration. However, we note the requirements of VA in providing
required nursing home care under section 1710A is due to expire
December 31, 2013. We also note enactment of this provision would
require technical changes in other sections of title 38 referencing
subsection 1710(a)(4).
Section 6 would insert a new section (1729B) in title 38 to
establish the ``Medicare VA reimbursement program'' for the purposes of
recovering from the Department of Health and Human Services those costs
to VA from providing treatment for a nonservice-connected condition to
a Medicare-eligible veteran.
DAV has no resolution on this section and takes no formal position.
However, notwithstanding the ``Sense of Congress'' provision, which is
not enforceable on Congress or the Administration, that reimbursements
received by VA from HHS \6\ ``should not be'' used to reduce VA
discretionary appropriations, history shows that third-party
reimbursements have indeed been used to offset VA medical care
discretionary appropriations despite the original intent.
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\6\ Sec. 1729B (c)(5) ``Any payment made to the Department under
this subsection shall be deposited in the Department of Veterans
Affairs Medical Care Collections Fund under section 1729A of this
title.''
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History has also shown that VA does not have a good record of
meeting projected amounts to be collected from reimbursements and must
then operate a health care system with less funds than needed to meet
the demand for care and services.
draft bill, the enhanced dental care for veterans act of 2013
This measure would authorize VA to establish a three-year pilot
program in at least 16 locations to assess the feasibility and
advisability of furnishing dental care to veterans enrolled in the VA
health care system who are not eligible under current authorities for
VA dental care. In addition, this bill would extend for an additional
two years the VA Dental Insurance Program (VADIP) for veterans and
survivors and dependents of veterans mandated under Section 510 of
Public Law 111-163.
The legislation also requires VA to establish a mechanism to add
any dental care treatment information provided by private providers
under VADIP in VA's Computerized Patient Record System (CPRS). Until
recently, the discretionary nature of receiving any treatment
information from a non-VA provider and electronically associating it
with a veteran treatment file in CPRS has traditionally not been
successful particularly if there is no requirement that submission of
such records to VA was a condition to receive payment from the
Department or that it is required by VA policy to include such records
in CPRS. While we are supportive of the intent in Section 5, we believe
there will be limited success without an incentive or disincentive for
the transmission or receiving end of such information.
DAV is pleased to support this measure based on DAV Resolution No.
072, supporting legislation to amend title 38, United States Code,
section 1712, to provide outpatient dental care to all enrolled
veterans. However, DAV opposes subsection (g), the copayment provision
under the VA provided dental care pilot program in accordance with our
Resolution No. 194, calling for the elimination or reduction of VA
health care out-of-pocket costs for service-connected disabled
veterans.
draft bill, the mental health support for veterans families and
caregivers act of 2013
The Mental Health Support for Veterans Families and Caregivers Act
of 2013 would require the Secretary of Veterans Affairs to conduct an
education program and peer support program for family members and
caregivers of veterans with mental health disorders. The goal of the
measure is to educate and train the family members and caregivers in
how to cope with mental health disorders in veterans and would take
place over a four-year period, with the Secretary being authorized to
extend the duration of the education program for an additional four
years. Eligible veterans are those who are enrolled in the VA health
care system.
The bill would mandate VA to establish the education program in at
least 10 VA medical centers (VAMCs), Community-Based Outpatient Clinics
(CBOCs), and Vet Centers. Additionally, the Secretary must consider the
feasibility of selecting locations in rural areas, areas not in close
proximity to an active duty location and areas in different geographic
locations. Two years after the start of the program, the Secretary
would be required to expand locations to at least 10 more VAMCs, 10
more CBOCs, and 10 more Vet Centers.
In order to facilitate the program, the Secretary is required to
enter into contracts with nonprofit entities with experience in mental
health education and outreach to include work with children, teenagers
and young adults. These groups must use high quality, relevant and age-
appropriate information in their educational materials and coursework.
The nonprofit entities must work with agencies, departments, nonprofit
mental health organizations, early childhood educators and mental
health providers to develop the educational programming, materials and
coursework. The Secretary would give priority entering into contracts
with entities that also use Internet technology for delivery of course
content in order to expand the availability of support services,
especially in rural areas.
The education component of the program would consist of at least 10
weeks of general education on different mental health disorders with
information on understanding experiences of persons suffering from the
disorders; techniques for handling crisis situations and administering
mental health first aid; techniques for managing stress affiliated with
living with a person with a mental health disorder; information on
additional services available for family members and caregivers through
VA or community organizations as well as mental health providers.
The instructors of the education program must be proficient in the
course of education and able to prove their level of proficiency to the
Secretary. Two years after the program has begun, those who have
successfully completed the course of education as well as any
additional training that may be required, may act as an instructor in
the education course. The Secretary will select mental health care
providers to monitor the instruction of the education program along
with primary care providers. The mental health providers will monitor
instructors by meeting with them quarterly, and at a minimum of twice a
year will submit a report on the progress of the instruction provided
in the education program to the Secretary.
The peer support program will be conducted at the same locations
the Secretary chooses for the education program and will consist of
group meetings at least twice each calendar quarter between a peer
support coordinator, family members and caregivers of eligible veterans
on matters related to coping with mental health disorders in veterans.
The medical facility director of each participating facility shall
select an individual who has completed a course of education and
maintains proficiency to serve as a peer support coordinator. A mental
health care provider selected by the Secretary would be required to
mentor each peer support coordinator and will meet with them quarterly
to monitor progress of the program, and at a minimum of twice a year
will submit a report on the progress of the peer support program to the
Secretary.
The measure would also require the Secretary to conduct a
comprehensive and statistically significant survey of individuals who
have participated in the education and peer support programs to include
their level of satisfaction, perceived effectiveness and applicability
of the programs. This information is to be included in a mandated
annual report due no later than one year after the start of the
education program, and no later than September 30 of every following
year until 2017. In addition to the survey results, the report must
include the number of participants in each program, analysis of the
surveys, summary of feedback from the mentors and monitors, and the
degree to which the veterans and family members and caregivers are
aware of the eligibility requirements for enrollment in both programs.
The report must also note any plans for expansion of the programs and
interim findings and conclusions of the Secretary with respect to the
success of the programs. The bill requires the mandated report to be
submitted to the Committees on Veterans' Affairs of the Senate and
House.
The final report would be due to the Committees on Veterans'
Affairs of the Senate and House no later than one year after the
completion of the education program regarding the feasibility and
advisability of the education and peer support programs to include
analysis of the surveys, viability of continuing the education program
without entering into contracts and instead using peer support
coordinators selected as instructors of the education course as well as
comments on expanding both programs.
In accordance with DAV Resolution No. 166, DAV is pleased to
support the Mental Health Support for Veterans Families and Caregivers
Act of 2013. DAV Resolution 166 calls on the Secretary of Veterans
Affairs to establish appropriate and effective programs to ensure that
veterans who are enrolled in VA health care receive adequate care for
their wounds and illnesses, including mental health-related illnesses,
and, when appropriate, family members--whether family caregivers,
spouses or other family dependents--receive necessary counseling,
including psychological counseling, training and other mental health
support services authorized by law to aid in the recovery of veterans.
VA treats a large patient population of veterans suffering from
chronic effects of PTSD, depression and other serious mental illnesses.
Many of these veterans suffer marriage and relationship breakdown,
under-employment or loss of employment, financial hardship, social
alienation and even homelessness. When a veteran experiences emotional
distress and or mental decompensation, the consequences of that
behavioral health event often fall directly on the veteran's family
members and caregivers. Experts argue that support of family members
and caregivers is often vital to a veteran's gaining and maintaining
emotional stability and eventual recovery from mental illness.
Currently, title 38, United States Code, subsection 1712A(b)2
authorizes the VA Readjustment Counseling Service, through its Vet
Center program, to provide psychological counseling and other necessary
mental health services to family members of war veterans under care in
such Vet Centers, irrespective of service-connected disability status.
Section 301 of Public Law 110-387 authorizes marriage and family
counseling in VA facilities to address the needs of veterans' families,
including spouses and other dependent family members of veterans who
are experiencing mental health challenges with attendant marital or
family difficulties. Public Law 111-163 authorizes a wide array of
support, care and counseling services for personal caregivers of
severely injured or ill veterans from all eras of military service.
Additionally, title 38, United States Code, section 1782 authorizes
a program of counseling, training, and mental health services,
including psychological support, for immediate family members of
disabled veterans who need care for service-connected disabilities; who
have service-connected disabilities rated at 50 percent or more
disabling; who were discharged or retired from the Armed Forces for
injuries or illnesses incurred in line of duty; who are World War I or
Mexican Border Period veterans; who were awarded the Purple Heart; who
are former prisoners of war; who were exposed to radiation or toxic
substances; or, who are unable to defray the expenses of their care.
This measure would expand education, training and psychological
support, for family members and caregivers of enrolled veterans with
mental health disorders.
draft bill, the medical foster home act of 2013
This bill would authorize the Secretary of Veterans Affairs to
cover the costs associated with the care of veterans at medical foster
homes.
VA inspects and approves Medical Foster Homes, which are private
homes with a trained caregiver providing needed services to a few
individual residents. A Medical Foster Home may be appropriate for
veterans who would otherwise be placed in a nursing home because they
lack the support network necessary to remain in their own home.
VA ensures the caregiver is both well trained to deliver VA's
planned care for the veteran and is on duty 24 hours a day, 7 days a
week. While living in a Medical Foster Home, veteran residents are
enrolled in the VA Home Based Primary Care program and care is provided
by an interdisciplinary team that offers a broad array of supportive
services.
DAV is pleased with VA's innovation by offering medical foster
homes as part of its long-term care program. While patient
participation in this program is voluntary, it yields exceedingly high
satisfaction among veteran residents. In addition, because of its low
cost, many VA facilities perceive this program as a cost-effective
alternative to nursing home placement and it is gaining popularity
based on the expansion of this program over the last several years.
However, based on DAV Resolution No. 198, supporting legislation to
expand the comprehensive program of long-term services and supports
(LTSS) for service-connected disabled veterans, and as part of the IB,
DAV is greatly concerned that veterans living in medical foster homes
are required to use personal funds, include VA disability compensation,
as payment.
Because this program operates under VA's community residential care
authority, veterans in medical foster home programs have to pay for
their care, which range from about $50 to as much as $150 a day. Even
veterans who are otherwise entitled to nursing home care fully paid for
by VA, whether it is under the law or by VA's policy must pay to reside
in a Medical Foster Home. Moreover, service-connected veterans who do
not have the resources to pay a medical foster home caregiver may not
avail themselves of such an important benefit.
We thank the Chairman for introducing this measure, which would
give VA the authority to pay for those costs service-connected veterans
must currently pay out-of-pocket to reside in a VA approved medical
foster home.
DAV is pleased to support the intent of this bill; however, because
current statutory authority prohibits VA from meeting is mandatory
obligations in providing long-term services and supports to service-
connected disabled veterans, we believe the intent of this legislation
should be codified.
draft bill, the scra enhancement and improvement act of 2013
The SCRA Enhancement and Improvement Act of 2013 would amend the
Servicemembers Civil Relief Act to extend the interest rate limitation
on debt entered into during military service to debt incurred during
military service to consolidate or refinance students loans incurred
before military service.
DAV does not have a resolution on this issue and takes no official
position, but would not oppose enactment of such legislation.
draft bill, the improved compensation for hearing loss act of 2013
The Improved Compensation for Hearing Loss Act of 2013 would
require the Secretary of Veterans Affairs to submit reports on the
provision of services by the VA to veterans with hearing loss and other
auditory system injuries and the measures that can be taken jointly by
the VA and the DOD with respect to hearing loss and other auditory
system injuries.
Specifically, if enacted, this proposed legislation would allow the
Secretary one year from the date of such enactment to report to
Congress on the actions taken to implement the directives in Public Law
107-330, the Veterans Benefits Act of 2002, with respect to a
longitudinal study of hearing loss and tinnitus since World War II, and
the implementation of findings and recommendations of the pursuant
comprehensive 2006 report by the Institute of Medicine titled, ``Noise
and Military Service: Implications for Hearing Loss and Tinnitus.''
This measure requires the Secretary's report to include an
evaluation as to the number of veterans who had a military occupational
specialty (MOS) not included in the Duty Military Occupational
Specialty Noise Exposure Listing (MOS List) that are precluded from
receiving hearing loss benefits from VA. This measure also requires the
Secretary to report the number of veterans who had an MOS listed on the
MOS List that were granted and denied benefits for hearing loss; and of
those veterans with an MOS not listed on the MOS List, the number that
were granted and denied entitlement to hearing loss benefits, as well
as the number of those denied that were successfully granted on appeal.
While this proposed legislation is one of reporting requirement in
nature, of particular interest to DAV is the requirement for the
Secretary to provide an explanation of the rationale for the practice
of not issuing a compensable rating for hearing loss that is severe
enough to necessitate the use of hearing aids. This particular
provision in the proposed legislation is directly in line with a long-
standing DAV resolution, as well as in consensus with the other
Independent Budget VSOs, as it has been recognized that certain
veterans may suffer from hearing loss to the degree of requiring a
prescribed hearing aid, but are not able to receive compensation.
In fact, the VA Schedule for Rating Disabilities (VASRD) contained
in title 38, Code of Federal Regulations, part 4 does not provide a
compensable rating for hearing loss at certain levels severe enough to
require the use of hearing aids. The minimum disability rating for any
hearing loss severe enough to require use of a hearing aid should be 10
percent, and the VASRD should be amended accordingly.
A disability severe enough to require use of a prosthetic device
should be compensable. Beyond the functional impairment and the
disadvantages of artificial hearing restoration, hearing aids
negatively affect the wearer's physical appearance, similar to scars or
deformities that result in cosmetic defects. Also, it is a general
principle of VA disability compensation that ratings are not offset by
the function artificially restored by a prosthetic device.
For example, a veteran receives full compensation for amputation of
a lower extremity although he or she may be able to ambulate with a
prosthetic limb. Additionally, a review of title 38, Code of Federal
Regulations, Part 4 [VASRD] shows that all disabilities for which
treatment warrants an appliance, device, implant, or prosthetic, other
than hearing loss with hearing aids, receive a compensable rating.
Assigning a compensable rating for medically prescribed hearing
aids would be consistent with minimum ratings provided throughout the
VASRD. Such a change would be equitable and fair.
While DAV appreciates the proposed legislation requiring the
Secretary to provide an explanation, we believe this provision would
merely allow VA the opportunity to prolong this inequitable issue. In
accordance with DAV Resolution No. 111, DAV recommends this provision
of the proposed legislation be changed from requiring the Secretary to
provide an explanation to that of amending the VASRD to provide a
minimum 10 percent disability rating for any service-related hearing
loss medically requiring a hearing aid.
Although we do not have a resolution to support the other reporting
requirements of this proposed legislation, DAV is not opposed enactment
of those provisions, provided they do not overburden VA at a time where
transformation of the claims process and reducing the backlog of
pending disability claims is paramount.
draft bill, the survivors of military sexual assault and
domestic abuse act of 2013
The Survivors of Military Sexual Assault and Domestic Abuse Act of
2013 would expand subsection (a) of section 1720D of title 38, United
States Code, and authorize the VA to provide counseling and treatment
for sexual trauma to members of the Armed Forces including the National
Guard and Reserves to aid in their overcoming psychological trauma. A
referral will not be required before an individual receives counseling
and care. Some technical aspects of the measure include amending the
law to be gender neutral.
Section 3 of the bill would require the VA Secretary, no later than
540 days after enactment of the Act, to develop and implement a
screening mechanism to be used when veterans seek health care services
from VA to identify if the veteran has been a victim of domestic abuse.
The purpose of this provision is to improve treatment of the veteran
and assess prevalence of domestic abuse in the veteran population.
Domestic abuse, in part, is defined as behavior that constitutes a
pattern of physical or emotional abuse, economic control or
interference with personal liberty, or a violation of Federal or state
law involving the attempted, threatened, or actual use of force or
violence against the person, in addition to a violation of a protective
order. In order to qualify as domestic abuse, the behavior is committed
by a current or former spouse or domestic partner, or a person that
shares a child with the individual, is a current or former intimate
partner that shares or has shared a common residence or is a caregiver
of the individual as defined in section 1720G(d) of title 38, United
States Code, or in any other type of relationship with the individual
that the Secretary may specify for this purpose.
Section 4 of the legislation would require the VA Secretary, within
a year after enactment of the Act, to submit a report to the Committees
on Veterans' Affairs of the Senate and House and detail the treatment
and services available from VA for male veterans who experience
military sexual trauma (MST) compared to the treatment and services
available to women veterans who experience MST. The Secretary would
also be required to include a report on domestic abuse among veterans
that specifies the types, outcomes, and circumstances of domestic abuse
incidents reported by veterans over the two-year period preceding the
submission of the report as well as a summary of the treatments
available from VA for sufferers of domestic abuse and whether an
incident of MST experienced after the age of 18 may increase the risk
for domestic abuse along with any other issues the Secretary deems
appropriate.
Additionally, within a year after enactment of this Act and
annually thereafter for five years, the VA/DOD Joint Executive
Committee would be required to submit a report on MST and domestic
abuse that details the processes and procedures utilized by VA and DOD
to facilitate transition of treatment of those who have experienced
either of one these to include treatment provided by both Departments.
The report must also include a description and assessment of VA/DOD
collaboration assisting veterans in filing claims for disabilities
related to MST or domestic abuse, including permitting veterans access
to information and evidence necessary to develop or support such
claims.
The continued prevalence of sexual assault in the military is
alarming and often results in lingering physical, emotional or chronic
psychological symptoms in assault survivors. The DOD's Office of Sexual
Assault Prevention and Response (SAPRO) reports that over 3,000 sexual
assaults are reported each year across the military services and
estimates that approximately 87 percent of all sexual assaults go
unreported, therefore approximating more than 26,000 sexual assaults
occur each year in the military services. Likewise, more than 20
percent of women and over one percent of men enrolled in the VA health
care system report they had experienced military sexual trauma (MST).
MST-related outpatient treatment encounters total nearly 800,000 clinic
visits each year in the VA.
For these reasons, DAV is pleased to support the Survivors of
Military Sexual Assault and Domestic Abuse Act of 2013. DAV Resolution
No. 125, in part, urges VA to continually improve its MST treatment
programs. DAV wants to ensure all MST survivors, male and female, gain
open access to the specialized treatment programs and services they
need to fully recover from sexual trauma that occurred in military
service. We appreciate the intent of the bill to improve better
collaboration between DOD and VA, specifically related to transition
from military service to veteran status, as it is essential in
achieving this goal. Due to the stigma and sensitive and personal
nature of sexual assault, coupled with the unique and complex military
hierarchy, rules and regulations that servicemembers are subjected to,
it appears it would be extremely beneficial for active duty
servicemembers, including National Guard and Reserve troops, to have
access to MST counseling and care from VA. Although DAV does not have a
specific resolution related to domestic abuse screening or required
reports, we have no objection to those provisions in the bill.
DAV also suggests the Committee consider adding a provision in the
bill related to MST care and beneficiary travel reimbursement. As a
result of VA clinical determinations, some veterans are referred to VA
medical facilities other than their local facilities or closest
Veterans Integrated Service Network to receive the specialized MST care
they need. The VA Office Inspector General (IG) conducted a healthcare
inspection of inpatient and residential programs for female veterans
with mental health conditions related to MST. The IG found that
obtaining authorization for travel funding was frequently cited as a
problem for patients and staff.
According to the IG, the VA's current policy in beneficiary travel
indicates that only selected categories of veterans are eligible for
travel benefits and payment is only authorized to the closest facility
providing comparable service. The IG points out that this Directive is
not aligned with the MST policy that states that patients with MST
should be referred to programs that are clinically indicated regardless
of geographic location. If a VA clinician determines an MST survivor
needs specialized care from a VA MST inpatient facility, VA's
beneficiary travel policy may serve to obstruct access to that unique
resource, or force an MST survivor to self-pay all travel costs in
order to gain access to these specialized services. For these reasons,
DAV supports legislation to change beneficiary travel policies to meet
the specialized clinical needs of veterans receiving MST-related
treatment in accordance with DAV Resolution 125.
draft bill, to expand and facilitate compensation of veterans for
illnesses associated with exposure to toxic substance during service on
active duty in the armed forces
This bill would amend title 38, United States Code, to expand and
facilitate compensation of veterans for illnesses associated with
exposure to toxic substance during service on active duty in the Armed
Forces. Although DAV has two resolutions on providing health care and
benefits for veterans exposed to toxic substances while on active duty,
we have not had sufficient time to review this bill thoroughly. We ask
the Committee to allow DAV to submit supplemental comments on this
legislation for the record, after we have had time to fully analyze
this draft legislation.
draft bill, to provide a limited exception to the 24-month requirement
in order for veterans enrolled in the va health care system to be
eligible for payments or reimbursement for non-va emergency treatment
This bill proposes a limited exception to the 24-month requirement
in order for veterans enrolled in the VA health care system to be
eligible for payment or reimbursement for non-VA emergency treatment
under title 38, United States Code, section 1725.
DAV Resolution No. 212 supports legislation to amend title 38,
United States Code, to eliminate the provision that requires enrolled
veterans to have received care from VA within the 24-month period prior
to date of the emergency care. DAV believes a health care benefit
package is incomplete without a provision for emergency care.
Accordingly, the 24-month requirement under Sec. 1725 discriminates
against otherwise healthy veterans who need not seek care at least once
every 24 months, yet is required to make an otherwise unnecessary
medical appointment in order to be eligible for payment or
reimbursement for non-VA emergency treatment.
While DAV supports the concept of the legislation, which is to
address the restrictive nature of the 24-month requirement included in
Sec. 1725(b)(2)(B). We are concerned with the measures approach, which
further fragments an already poorly constructed eligibility criterion,
by providing relief to only ``new veteran patients'' with the ``safety
net'' of non-VA emergency coverage.
Notably, ``established patients'' represent approximately 90
percent of VHA's total outpatient appointments. Currently, the VHA
defined ``established patients'' as those who have received care from a
qualifying provider in a specific clinic in the previous 2 years; ``new
patients'' represent all others.
VA examines wait times for completed appointments with the ultimate
goal of delivering high quality service at the time wanted and needed
by each veteran. In 2014, VA will measure wait times for primary care,
specialty care, and mental health appointments for new and established
patients. In 2013, VA updated the methodologies to measure wait times
for ``new'' and ``established patient'' appointments to improve
reliability and consistency. Appointments for ``new patients'' will use
the create date, defined as when the appointment was made and
automatically captured by the scheduling system. Appointments for
``established patients'' will use the desired date, defined as the
agreed upon date determined together by provider and patient. Desired
date is measured prospectively to better represent patient
satisfaction. Therefore, no targets are set in 2013 and 2014 so that
baseline performance can be established.
We also note the ill-defined legislative text ``a waiting period
imposed by the Department'' pertaining to wait times associated with a
newly enrolled veteran's initial appointment at a VA medical facility
is especially problematic. In determining ``a waiting period,'' this
Committee is aware of continuing reliability issues of VA reported
outpatient medical appointment wait times and the need for improving
appointment scheduling oversight.\7\
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\7\ Reliability of Reported Outpatient Medical Appointment Wait
Times and Scheduling Oversight Need Improvement, Government
Accountability Office, December 21, 2012. Washington, DC.
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draft bill, to require entities that receive per diem payments through
va, for the provision of services to homeless veterans, to submit an
annual certification to the secretary of veterans affairs proving that
the building where the entity provides housing or services is in
compliance with codes relevant to the operations and level of care
provided
This draft bill would amend title 38, United States Code, to
require entities that receive per diem payments through VA, for the
provision of services to homeless veterans, to submit an annual
certification to the Secretary of Veterans Affairs proving that the
building where the entity provides housing or services is in compliance
with codes relevant to the operations and level of care provided.
The certification would include compliance with requirements
outlined in the recently published version of the Life Safety Code or
such other comparable fire and safety requirements as the Secretary may
specify. Additionally, all licensing requirements regarding the
condition of the structure and the operation of supportive housing or
service center, including fire and safety requirements, must be
provided.
DAV previously testified on a similar bill, H.R. 2065, introduced
in the 113th Congress. While we did not have a National Resolution from
our membership specifically covering the state of the housing provided
to veterans or the safety of the facilities where homeless services are
provided, we did not oppose favorable consideration of the legislation.
However, we testified that H.R. 2065 may adversely impact Grant and Per
Diem providers, which could leave many homeless veterans and their
families without the services they need.
For entities that receive per diem payments during the year in
which the legislation is enacted, the recipient must submit all
certifications required to the Secretary no later than two years after
the date of enactment, or additional per diem payments will be halted
until certification is received. Both the Senate and House versions
contain similar language; leaving the question unanswered as to what
would become of the homeless veterans in these programs where their
facilities fail to produce the mandated documentation?
While DAV agrees with the intent of the measure to provide safe
shelters for our homeless veterans, we urge the Senate to work with the
House to mitigate any detrimental effects this bill may have while
meeting the needs of homeless veterans in a safe environment. Both
bills contain sound components. They can be modified slightly to
produce a comprehensive piece of legislation that takes into
consideration the potential impact on homeless veterans that are
serviced by grant recipients that fail to meet the criteria set forth
in the legislation.
draft bill, to rename the bay pines va healthcare system
This bill would redesignate the Department of Veterans Affairs
Healthcare System located at 10000 Bay Pines Boulevard in Bay Pines,
Florida, as the ``C.W. Bill Young Department of Veterans Affairs
Medical Center.''
This is a local issue. DAV does not have a national position on the
matter.
draft bill, the servicemember housing protection act of 2013
This bill would amend the Servicemembers Civil Relief Act to
enhance the protections accorded to servicemembers and their spouses
with respect to mortgages.
DAV does not have a resolution on this issue and takes no official
position, but would not oppose enactment of such legislation.
draft bill, the support of joint federal facilities act of 2013
This measure would provide VA the authority to enter into
agreements with the Department of Health and Human Services (HHS) to
share medical facilities with the goal of improving access to, and
quality and cost effectiveness of, health care furnished by HHS. Funds
transferred from the Department's accounts for medical care, and major
and minor construction would be used in conjunction with HHS funds.
DAV has no resolution on sharing medical facilities with HHS;
however, National Resolution No. 188 calls on Congress to carefully
monitor any intended changes in VA infrastructure that could jeopardize
VA's ability to meet veterans' needs for primary and specialized VA
medical care and rehabilitative services.
Although DOD and VA have shared resources at some level since the
1980s, shared facilities with DOD have raised DAV's concerns over VA's
ability under such sharing to ensure its resources are used in a cost-
effective manner for the care and rehabilitation of ill and injured
veterans. Through their reports, the Government Accountability Office
appears to validate our concerns in sharing facilities and
resources.\8\
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\8\ VA Health Care: Additional Efforts to Better Assess Joint
Ventures Needed, GAO-08-399 (Washington, DC: Mar. 28, 2008); VA and DOD
Health Care: First Federal Health Care Center Established, but
Implementation Concerns Need to Be Addressed, GAO-11-570 (Washington,
DC: July 19, 2011); Electronic Health Records: DOD and VA Should Remove
Barriers and Improve Efforts to Meet Their Common System Needs, GAO-11-
265 (Washington, DC: Feb. 2, 2011); Costly Information Technology
Delays Continue and Evaluation Plan Lacking, GAO-12-669 (Washington,
DC: June 26, 2012); Department-Level Actions Needed to Assess
Collaboration Performance, Address Barriers, and Identify
Opportunities, GAO 12-992 (Washington, DC: Sept. 28, 2012).
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Like the original authorization provided to VA and DOD for a five-
year demonstration project to integrate VA and DOD medical care into a
first-of-its-kind Federal Health Care Center in North Chicago,
Illinois, we ask the Committee to first consider a demonstration
project for this new authority. Moreover, we ask the Committee consider
additional provisions on VA and HHS to develop performance measures to
show the extent of progress for effective management and strategic
planning, and to assess the effectiveness and efficiencies in the
provision of care and operations.
Mr. Chairman, this concludes my testimony and I would be happy to
answer any questions from you or members of the Subcommittee.
Chairman Sanders. Thank you very much, Mr. Atizado, and
thank you for what the DAV is doing.
Colonel Norton.
STATEMENT OF COLONEL ROBERT F. NORTON, USA (RET.), DEPUTY
DIRECTOR, GOVERNMENT RELATIONS, MILITARY OFFICERS ASSOCIATION
OF AMERICA
Colonel Norton. Thank you, Mr. Chairman. It is an honor to
be here with you today. Thank you Senator Burr, Senator
Blumenthal. I represent some 380,000 members of the Military
Officers Association of America.
Mr. Chairman, three of the bills on the agenda today would
amend the Servicemembers Civil Relief Act or SCRA. Your bill,
the SCRA Enhancement and Improvement Act makes a number of key
improvements that support our active duty, National Guard, and
Reserve members called to active Federal service.
I believe it is important to set this bill in a proper
context. Since September 11, 2001, almost 900,000 members of
the Guard and Reserve have been called up and over 300,000 have
served on multiple tours of active duty. Reliance on our
citizen soldiers has never been greater.
It is, in fact, our national policy that reservists can
expect to be activated 1 year or every 5 years they are
training part time at home. The legislation is also important,
very important for active duty families.
The SCRA Enhancement and Improvement Act expands mortgage
protections for service families required to move under
military orders. It preserves civilian licenses and
certifications that may expire during a combat zone deployment,
and it prevents a servicemember from being denied or refused
credit solely by reason of eligibility for the SCRA among other
objectives in the bill.
Senator Jack Reed's Servicemember Housing Protection Act,
S. 1593, complements your bill, Mr. Chairman. It includes a
provision that extends SCRA mortgage foreclosure protection for
1 year to the surviving spouses of servicemen and women who
made the ultimate sacrifice or who died in the line of duty.
Another provision in the bill allows a military family who
is renting off post housing to be able to break a residential
lease without penalty in the event that on base housing opens
up.
The bill would also trigger SCRA protections with a
commanding officer's letter that would serve as a type of
military order. Together these bills straighten the morale,
well-being, and readiness of our Nation's military families.
The Military Officers Association strongly supports these
measures.
S. 1399, the Servicemember Student Loan Affordability Act,
sponsored by Senator Durbin, is beneficial to young people with
multiple student loans who agree to join our Armed Forces.
The bill allows them to consolidate student loan debt and
gain the SCRA 6 percent interest rate cap. We believe this bill
also supports recruitment of talented Americans with unique
skills in demand by our Armed Forces.
Senator Tester's S. 1573 would allow the VA to make faster
payments of DIC compensation to surviving spouses while formal
paperwork is in the pipeline. We strongly support this bill.
S. 1262, the Veterans Conservation Corps, sponsored by
Senator Bill Nelson, would establish a new program to support
veterans transition to civilian life via temporary employment
in conservation programs, law enforcement, firefighting, and
disaster relief.
MOAA supports the bill in concept but we recommend that the
legislation include an explicit authority to use GI Bill
training benefits so that participants can gain a license or
other credential at the conclusion of their training.
Turning briefly to VA health care legislation, we support
your bill, Senator Burr, draft bill that would establish an
outside independent study of the 21 VA Veterans Integrated
Service Networks, or VISNs, to ensure that the system is
working efficiently and effectively.
Mr. Chairman, we understand that your bill, the Veterans
Health Care Eligibility and Expansion Enhancement Act is being
parsed into two bills. MOAA strongly supports expanding
enrollment opportunities for certain uninsured veterans
consistent with the requirements of the Affordable Care Act.
Finally, MOAA strongly supports the provision in the bill
that extends the period of time combat veterans can enroll in
VA health care from 5 years to 10 years.
This concludes my statements. Mr. Chairman, thank you very
much. I look forward to your questions.
[The prepared statement of Colonel Norton follows:]
Prepared Statement of the Colonel Robert F. Norton, USA (Ret.), Deputy
Director, Government Relations, Military Officers Association of
America
Chairman Sanders, Ranking Member Burr and Distinguished Members of
the Committee, On behalf of the over 380,000 members of The Military
Officers Association of America (MOAA), I am pleased to present the
Association's views on selected bills under consideration at today's
hearing.
MOAA does not receive any grants or contracts from the Federal
Government.
s. 1148, veterans benefits claims faster filing act (sen. heinrich, d-
nm).
S. 1148 would require the Department of Veterans Affairs (DVA) to
compare the average claim processing time for various veterans'
benefits depending on the method of filing, and to compare the grant of
veterans' benefits among represented and unrepresented veterans. The
bill would make these reports available in each regional office and on
the VA's Web site.
The data on benefits grants percentages would be reported based on
whether the veteran was unrepresented, represented by a veteran service
organization representative, or represented by another individual
(usually an agent or attorney). The data on average processing time
would compare processing time for two variables in claim filing
methods: paper versus electronic filing, and fully developed claim
filing versus non-fully developed claim filing.
MOAA is supportive of directing the Secretary to provide
information about the effect of representation on grants of veterans'
benefits. However, we are concerned that the report should compare like
data points: many attorneys and agents screen cases and focus on
representation of appeals, whereas veteran service organization
representatives represent almost any claimant and provide complete
claims service through the agency. We suggest that the Department of
Veterans Affairs be directed to provide grant percentages for both
original claims and appeals, and to provide an explanation of how the
data is obtained.
MOAA is also supportive of directing the Secretary to analyze the
results of VA's transformation to fully developed claims and electronic
processing by reporting the average claim processing times. However,
again, we are concerned that the report should compare like data as
more veterans and representatives choose to use electronic filing
methods and participate in the fully developed claims program.
We suggest that only the types of claims eligible for the fully
developed claim program and electronic processing be included in this
report, to make a direct comparison of the different filing methods.
Also, we suggest that the form numbers (i.e., 21-526ez) or the
breakdown on the VA's Monday Morning Workload Reports (i.e., by initial
claim for compensation, less than seven issues) be used to separate
results, so that claims for similar benefits can be compared. Certain
benefits may lend themselves to the fully developed claim process and
others may not.
We also suggest that the definition of ``claim'' include not only
the ``rating bundle'' used to define VA's progress on the claims
backlog and quality improvement measures, but also the ``award
adjustment'' of a dependency claim. Although data on the average claim
processing time of dependency claims may not be included in the VA's
aspirational goals, it is very important in understanding that the way
a claim is filed matters to the timeliness of a decision.
MOAA also would recommend the language of ``durable power of
attorney'' be changed to ``VA limited durable power of attorney,'' to
reflect that a power of attorney to represent a veteran in matters
before the Department of Veterans Affairs has no effect on health and
medical care decisions and other legal matters beyond the authorization
on VA Form 21-22 or 21-22(a).
MOAA is supportive of the intent of S. 1148, the Veterans Benefits
Claims Faster Filing Act, and recommends: the bill be amended as
outlined above; it reflect the nature of a VA power of attorney; and,
enhance the data collected for the benefit of veterans' benefits
claimants.
s. 1558, veterans outreach enhancement act of 2013 (sen. begich, d-ak)
S. 1558 would require the DVA to extend outreach services to
veterans via cooperative awareness programs with various Federal and
state agencies. The bill provides resource incentives for state, local
governments and veteran service organizations (VSOs) to assist veterans
in utilizing DVA facilities and resources available to them. Other
objectives of the legislation are to educate communities and State and
local governments about employment and reemployment rights of veterans
under the Uniformed Services Employment and Reemployment Rights Act
(USERRA); provides technical assistance to veteran owned businesses;
and, encourages non-profit groups, businesses and institutions of
higher education to assist veterans. MOAA supports S. 1558.
s. 1211, (sen. boxer, d-ca).
S. 1211 would prohibit the use of the phrases ``GI Bill'' and
``Post-9/11 GI Bill'' to give a false impression of approval or
endorsement by the Department of Veterans Affairs.
S. 1211 is consistent with recommendations that MOAA and other
military and veterans service organizations made to the President on
the issue of improving the oversight, outcomes reporting and consumer
education of Department of Defense (DOD) and Department of Veterans
Affairs (DVA) military and veterans educational benefit programs. Some
of those recommendations are included in Executive Order 13607,
Establishing Principles of Excellence for Educational Institutions
Serving Servicemembers, Veterans, Spouses and Other Family Members
(27 April 2012).
A specific MOAA recommendation reflected in Executive Order 13607
was to trademark the term ``GI Bill.'' Any entity that wishes to employ
the term ``GI Bill'' must gain the DVA's approval to use it.
Subsequently, ``GI Bill'' has been trademarked and the DVA is
responsible for enforcing its use. However, since trademarks are not
permanent, MOAA believes that S. 1211 is needed to ensure the terms
``GI Bill'' and ``Post-9/11 GI Bill,'' signifying taxpayer-provided and
government-administered educational programs for military members and
benefits, are permanently protected.
We would, moreover, recommend consideration of including the
phrases, ``military friendly schools'' and ``veteran friendly schools''
in the legislation, because these terms are bandied about by lead-
generators and marketing operations to imply quasi-government
endorsement, or unique services to student veterans that may not
actually exist at self-identified ``military friendly'' or ``veteran
friendly'' schools. We believe it's very important for our government
to provide reasonable consumer education protections for our returning
warriors as they separate from military service and re-engage with
their communities. MOAA endorses S. 1211.
s. 1262, the veterans conservation corps act of 2013 (sen. bill nelson,
d-fl).
S. 1262 would establish a veterans conservation corps to assist
veterans in the transition from military to civilian life and to employ
them in conservation, resource management and historic preservation
projects on public lands; and temporary employment as law enforcement
officers, firefighters, and disaster relief personnel.
MOAA appreciates Sen. Nelson's leadership on this issue but is
concerned over potential public perception and with veterans themselves
that the bill is a make-work program and not a true path to long-term
careers after military service.
S. 1262 does not appear to directly link the work and projects set
out in the legislation with appropriate formal training, licensing or
certification in the career areas described for GI Bill benefit
purposes. A provision should be included in the bill that directs the
Secretary of Veterans Affairs to establish approval of the training and
work experience by State Approving Agencies leading to award of
appropriate licensure or certification in specific fields in
conjunction with GI Bill program payments under Chapter 30 or Chapter
33, 38 U.S. Code. Another option to consider, instead of creating a new
program, is to increase job training, OJT and work-study reimbursement
rates under the Post-9/11 GI Bill and the Montgomery GI Bill.
MOAA is supportive of the intent of S. 1262 and recommends amending
the legislation to ensure veterans can receive a designated license,
certification or OJT credential under the GI Bill at the conclusion of
service in the veterans conservation corps. The legislation should lead
to clear long-term career opportunities for veterans.
s. 1295, (sen. brown, d-oh).
S. 1295 would require the VA to notify veterans (or their
representatives) that they may use a veteran service organization
representative (VSO) for the claims process when filing an electronic
claim. The bill states that notice should include a list of names and
web addresses for the VSOs. Currently, veterans receive a receipt for
electronic claims filed through VONAPP Direct Connect in the eBenefits
portal. There is a representative/agent/lawyer search in the eBenefits
portal already that does not include Web sites but does list
organization name, address and phone number. The VA Web site instructs
veterans to use the VSO search before filing a claim but there is no
such instruction in the eBenefits portal.
While MOAA supports the intent of the bill, the bill does not
require the same notification for veterans filing a paper based claim.
Veterans that file a fully developed paper claim through the mail using
VA Form 526-EZ do not receive a notification that they may use a VSO
until after the VA adjudicates their claim. MOAA recommends that the
bill be expanded to cover veterans that file formal and informal claims
by paper. MOAA supports the inclusion of web addresses for VSOs and
other representatives to the representative search function in
eBenefits.
MOAA is supportive of the intent of S. 1295, and recommends that
the bill be amended to provide notification to veterans and other
claimants that file claims by paper based methods.
s. 1361, world war ii merchant mariner service act (sen. murphy, d-ct).
S. 1361 is a bi-partisan, no-cost bill that expands and clarifies
the types of documentation for determining veterans status of certain
``coastwise merchant seamen'' (Merchant Mariners) during World War II,
and for other purposes.
The GI Bill Improvement Act of 1977 (Public Law 95-202) provided
that the Secretary of Defense could determine that service for the
Armed Forces by organized groups of civilians, or contractors, be
considered `active service' for benefits administered by the Veterans
Administration.
In the case of World War II Merchant Marines, documenting their
service has been difficult due to wartime security restrictions,
destroyed ship logs and unavailable merchant mariner documentation
known as a Z-card.
S. 1361 provides additional methods for documenting such service
for consideration as active service by the Secretary of Veterans
Affairs.
S. 1361 would authorize burial benefits; medals, ribbons and
decorations; and status as a veteran (with no additional benefits) for
Merchant Mariners who provide appropriate documentation under the bill.
The bill also permits a primary next-of-kin of deceased WWII Merchant
Mariners to submit evidence on their behalf of service to the United
States.
MOAA supports the World War II Merchant Mariner Service Act,
S. 1361.
s. 1399, the servicemember student loan affordability act (sen. durbin,
d-il)
S. 1399 would amend the Servicemembers Civil Relief Act (SCRA) to
extend the interest rate limitation of six percent (6%) in two ways. A
servicemember and the servicemember's spouse jointly who wish to
refinance a student loan debt incurred before entering the service
could do so at a rate not to exceed 6 percent. Under the bill, the 6%
rate cap also could be applied to a student loan debt incurred by a
servicemember and the servicemember's spouse jointly during military
service.
Servicemembers enjoy a 6% rate cap on all pre-service loans under
the SCRA. However, the law does not apply if a servicemember
consolidates student loans that were taken out before their military
service.
Loan consolidation is a practical, effective way to manage student
loan debt. It's also the only way a borrower who has a Federal Family
Education Loans (FFEL) or Perkins student loan can enroll in the
Federal Public Service Loan Forgiveness (PSLF) program, a program that
forgives student loan debt after 10 years of public service, including
military service.
Unfortunately, servicemembers with student loans taken out before
they joined the military who want their military service to count
toward the 10 years of public service required under the loan
forgiveness program must consolidate their student loans. But then they
promptly lose the 6% loan rate cap that is afforded them by the SCRA.
This legislation could be particularly beneficial for supporting
Armed Forces recruitment of highly qualified candidates with unique
skills in demand by the military. MOAA supports S. 1399, the
Servicemember Student Loan Affordability Act.
s. 1573 (sen. tester, d-mt).
S. 1573 is a bi-partisan bill that would authorize the Department
of Veterans Affairs (DVA) to immediately pay temporary Dependency and
Indemnity Compensation (DIC) for up to six months to surviving spouses
of fallen servicemembers and veterans who died of a service-related
disability.
S. 1573 is common sense, no-cost legislation that enables quick
payments from the DVA to eligible surviving spouses pending the receipt
of formal paper work. Under Secretary of Veterans Benefits, the
Honorable Allison Hickey, voiced the need for this legislation earlier
this year in response at a Congressional hearing.
The legislation provides a financial bridge to support the
essential needs of survivors who in many cases have endured hardship
caring for a seriously disabled veteran. MOAA strongly supports
S. 1573.
s. xxxx, servicemembers civil relief act (scra) enhancement and
improvement act of 2013 (sen. sanders, i-vt).
The SCRA Enhancement and Improvement Act incorporates a number of
needed technical fixes and enhanced protections for military women and
men called to active Federal service.
The SCRA was originally enacted in World War II when hundreds of
thousands of National Guard servicemembers and conscripts were being
called to the colors. The need then and today was to create a financial
and legal safety net primarily for our citizen-warriors and their
families so that they could focus on their mission.
After September 11, 2001 Congress adopted numerous upgrades to the
SCRA to protect the interests of active duty servicemembers and their
families, as well as the National Guard and Reserves when activated.
Almost 900,000 reservists have been activated since Sept. 11, 2001
and over 300,000 have been called up for second, third or fourth tours
of active duty. The Nation's reliance on the Guard and Reserve to
support national security objectives at home and overseas has never
been greater.
It is, in fact, our national policy to employ the Guard and Reserve
in the operating force on a routine basis for the indefinite future.
Under the DOD's ``operational reserve'' policy promulgated in
January 2007 by then-Secretary Robert Gates, reservists are expected to
be trained and ready for active duty service one year out of every
five. Many reservists have actually been deployed as frequently as
their active duty counterparts: three years' `at home' and one year
deployed. DOD leaders have indicated that the routine use of reserve
capabilities will continue after the withdrawal from Afghanistan (2014)
and the drawdown of the entire force as a result of sequestration and
budget uncertainties.
In this context, it's hard to overstate the importance of the SCRA
to morale, family well-being and military readiness.
The SCRA Enhancement and Improvement Act expands mortgage
protections for service families required to move under ``permanent
change of station'' (PCS) orders; preserves professional licenses that
expire during a combat zone deployment; protects service families
denied or refused credit solely because of the SCRA; raises financial
penalty limits for willful violation of the statute; provides the
Attorney General enforcement authority for the SCRA; and makes a number
of other changes as summarized below.
title i, scra enhancements
Section 101 would extend the coverage period for the protections
under installment sales contracts to one year after a period of
military service.
Section 102 would amend section 303(b) of the Servicemembers Civil
Relief Act (SCRA) by changing ``filed'' to ``pending'' so that
servicemembers may be eligible for stays of proceedings or adjustments
of an obligation on real or personal property even if the action was
filed before they entered service, or during a break in service.
Section 103 would prohibit the accrual of mortgage prepayment
penalties incurred during a period of military service when discharging
an obligation on a primary residence as the result of a receipt of
permanent change of station orders.
Section 104 would provide servicemembers with relief from
expiration of licenses or continuing education requirements during
periods of eligibility for hostile fire or imminent danger pay and for
an additional 180 days after such eligibility ends.
Section 105 would extend the protections preventing sale of
personal and real property to collect unpaid taxes or assessments
without a court order to real property owned by a business that is
owned entirely by a servicemember or a servicemember and the
servicemember's spouse.
Section 106 would prevent a servicemember from being denied or
refused credit solely by reason of eligibility for the SCRA.
title ii, scra improvements
Section 201 would clarify that the plaintiff in a default judgment
action has an affirmative obligation to determine the defendant's
military status and that the plaintiff must take steps accordingly,
including but not limited to reviewing available Department of Defense
records. It would also define the due diligence required of an attorney
appointed by the court to represent a defendant who may be in military
service.
Section 202 would prevent a waiver of a servicemember's SCRA rights
or protections until after the occurrence of the event that gave rise
to the rights or protections to be waived.
Section 203 clarifies that the Attorney General's authority to
enforce the SCRA and an individual's right to file a private right of
action existed before enactment of the Veterans' Benefits Act of 2010,
which made this right explicit.
Section 204 would apply the protections related to mortgages to
obligations on real or personal property for which a servicemembers is
personally liable as a guarantor or co-maker.
title iii, scra enforcement
Section 301 would make arbitration clauses unenforceable unless all
parties consent to arbitration after a dispute subject to the
provisions of the SCRA arises.
Section 302 would allow the Attorney General to issue civil
investigative demands in investigations under the SCRA. It does not
include the authority to compel oral testimony or sworn answers to
interrogatories.
Section 303 would increase the civil penalties for a first
violation of SCRA from $55,000 to $110,000 and for second or subsequent
violations from $110,000 to $220,000.
Informally, the Legal Assistance to Military Personnel (LAMP)
Committee of the American Bar Association supports this legislation as
do recognized reserve component legal experts.
MOAA strongly supports the Servicemembers Civil Relief Act (SCRA)
Enhancement and Improvement Act of 2013.
s. xxxx, the servicemember housing protection act of 2013
(sen. jack reed, d-ri)
The Servicemember Housing Protection Act would help military
families in three ways: first, by permitting a servicemember to
terminate a lease agreement under the SCRA in situations where
government housing suddenly opens up. Several states already have
similar laws, and this opportunity should be extended to servicemembers
serving at any of our military bases.
Second, the legislation enables military families to gain SCRA
protections with a letter from a commanding officer. There have been
many cases in recent years where servicemembers are activated prior to
the issuance of formal orders. The bill would apply the broader
definition of military orders, allowing for commanding officer letters
in all sections of the SCRA in which a servicemember is required to
submit copies of military orders. This change will make it easier for
servicemembers to more quickly get their affairs in order prior to
deployment.
Third, legislation would extend the twelve-month window of
foreclosure protections to surviving spouses. After suffering the
unspeakable loss of a military husband or wife in service to the
Nation, a surviving spouse should not have the additional burden of
dealing with the potential of a mortgage foreclosure.
MOAA strongly supports the Servicemember Housing Protection Act of
2013 to expand protections under the SCRA for military families and
surviving spouses.
s. xxxx, improving quality of care within the department of va act of
2013 (sen. burr, r-nc)
The Improving Quality of Care Within the Department of VA Act of
2013 addresses two distinctly separate issues. The bill would require
the DVA to ensure its policies regarding the reporting of infectious
diseases be current and consistent with State laws. This makes good
sense.
The second section of the bill requires that an outside independent
assessment of the 21 VISNs and medical centers be conducted to study,
evaluate and recommend organizational structures of medical centers;
identify which key leadership positions in Medical Centers and VISNs
should have succession plans and how to implement such plans.
The quest for standardization within the VA remains elusive. VISNs
are considered the communication channel for centrally developed
guidance to be sent out to the regions for local implementation.
Directives from VA Central Office can take significant periods of time
to be reviewed by local VA facilities and then may not be implemented
as originally intended. We support any efforts to better streamline and
standardize the VISN organizational structure.
MOAA supports the Improving Quality of Care within the Department
of VA Act of 2013
s. xxxx veterans health care eligibility expansion and
enhancement act of 2013 (sen. sanders, i-vt)
Section 3 of The Veterans Health Care Eligibility Expansion and
Enhancement Act of 2013 would expand access to VA health care for
service-disabled, non-compensable veterans with no health insurance.
Under the Affordable Care Act, VA health care is qualifying care for
purposes of meeting the requirements of the law. This provision would
enable this group of veterans to meet the ACA requirement via
enrollment in the VA health system. MOAA supports the provision that
expands access to VA care for certain uninsured veterans.
Section 4 of the bill would extend the period of time combat
veterans can enroll in VA health care post-deployment from five years
to ten years. MOAA strongly supports the provision that extends the VA
health care enrollment period from 5 years to 10 years for combat
veterans after returning from deployment.
Section 6 of the bill concerns VA Medicare Reimbursement.
Among Federal agencies, only the Indian Health Service is permitted
to accept Medicare reimbursement in its facilities. Medicare eligible
veterans are seen in the VA for service-connected conditions but often
rely on outside medical care for routine services provided under
Medicare, effectively splintering the continuity of health care.
Now is an opportune time to take a fresh look at allowing our
enrolled, non-service-connected, Medicare eligible veterans to utilize
the VA for all of their health care. More than 40% of enrolled veterans
are eligible for Medicare.
In effect, rules excluding use of Medicare funds in VA facilities
result in the government paying redundant costs for procedures and
tests performed by Medicare providers and then, again, in VA
facilities. That alone should be reason enough to consider using the VA
as a Medicare provider.
If the VA can deliver a Medicare-sponsored benefit (for non-
service-connected care) more efficiently than Medicare providers, while
eliminating duplicative medical procedures, all stakeholders and
especially veterans are likely to benefit.
Early in the last decade in separate Congressional sessions, the
Senate and House passed legislation authorizing a test of VA Medicare
Reimbursement to validate the theory that the government, taxpayers and
veterans would benefit under VA Medicare reimbursement. Limited
analytical studies also have been conducted on this issue and they
suggest potentially favorable outcomes from VA Medicare Reimbursement.
MOAA continues to support the concept that Medicare-eligible
veterans should be able to obtain their earned Medicare-sponsored
services for non-service-connected care in VA health care facilities.
Since the Senate Finance Committee has primary jurisdiction over
Medicare and Medicaid services, and due to earlier objections to
Medicare ``subvention'' in VA facilities, we would respectfully suggest
that the Committee consider sponsoring a formal test or pilot program
of VA Medicare Reimbursement if outright enactment of the proposal is
seen as infeasible at this time.
MOAA supports the establishment of a Medicare VA reimbursement
program for non-service-connected care of enrolled Medicare-eligible
veterans; we suggest that a formal pilot program may be the gateway to
gain broad Congressional support for the concept.
s. xxxx, mental health support for veteran families and
caregivers act of 2013 (sen. sanders, i-vt)
S.XXXX would direct the VA to provide support for family members
and caregivers of veterans with mental health disorders by establishing
mental health education programs and group peer support programs. Both
programs would be implemented via a contract with a non-profit entity
with experience in mental health education and outreach. The language
indicates that instructors for the group peer support meetings would be
selected from family members or caregivers who had completed the
initial training. It is not clear if these would be paid positions nor
what alternative would be used if none of the participants wished to
take on the responsibility of leading peer support groups.
MOAA is supportive of increasing support and education of
caregivers who are coping everyday with the stresses associated with
caring for our veterans with mental health (MH) concerns. Peer support
is a proven concept within the veteran population and would provide our
veteran families with a knowledgeable and safe place to learn,
understand and share how best to help their veteran suffering with
mental health problems. With the significant MH capabilities the VHA
has developed over the past several years, it may make sense to
consider utilizing internal assets to develop and implement these
programs rather than contracting out to organizations who do not have
the history and experience of veteran culture and healthcare.
MOAA supports the Veteran Families and Caregivers Act of 2013
s. xxxx enhanced dental care for veterans act (sen. sanders, i-vt)
This bill would create a three year pilot program providing dental
care and treatment to enrolled veterans who are not eligible for dental
care under current authorities. The pilot would be implemented in 16 VA
locations, including rural areas and services would be consistent with
the dental care provided to veterans with service-connected
disabilities rated at 100% disabled. In addition to VA dental
facilities, the services may be provided via contract by private
providers in the community. The pilot program would also include dental
health education be provided to the enrolled veteran via printed and
electronic materials.
MOAA supports the Enhanced Dental Care for Veterans Act of 2013.
s. xxxx survivors of military sexual assault and
domestic abuse act of 2013 (sen. sanders, i-vt).
This bill would authorize the DVA to provide care and treatment for
victims of sexual assault or domestic violence who are members of the
Armed Forces and requires the VA to screen veterans for sexual trauma
and domestic abuse.
MOAA strongly supports this legislation but requests clarification
of the language that describes the Armed Forces' eligible population.
Sec 2. Line 15 notes that counseling and care may be provided to
``members of the Armed Forces (including members of the National Guard
and Reserves) on active duty * * *'' We would request that language be
included that clarifies that members of the Reserve Components who
experienced sexual assault or domestic violence while on active duty
remain eligible to receive treatment from the DVA after returning to
drilling reserve status.
MOAA supports the Survivors of Military Sexual Assault and Domestic
Abuse Act of 2013.
Chairman Sanders. Thank you very much.
Mr. Weidman.
STATEMENT OF RICK WEIDMAN, EXECUTIVE DIRECTOR FOR POLICY AND
GOVERNMENT AFFAIRS, VIETNAM VETERANS OF AMERICA
Mr. Weidman. Thank you, Mr. Chairman and Ranking Member
Burr, for the opportunity to appear here today.
I was asked last night by my distinguished colleague, Mr.
Atizado, that he could not wait to try and see me comment on
every single bill on the agenda today. So, I am not even going
to try even though I have my fast New York accent when I need
it.
I will comment and thank Senator Richard Blumenthal for
moving forward on the Agent Orange Bill. It does a number of
things, this bill. One is the most emotional issue by far all
over this country is, among Vietnam veterans, is the issue of
the grandchildren.
When we first stumbled into this was a town meeting in
Louisville, Kentucky. Since that time, we have had such town
meetings from North Carolina to Florida to Vermont, et cetera.
Vermont actually was the first one we had but it did not
highlight the grandchildren. This was way back in 1983 that the
Chairman was involved in but it was all an Agent Orange.
We now have the biological plausibility and understand how
patrilineal defects and often anomalies can not only be visited
on the children but on the grandchildren. It is the field of
epigenetics which frankly did not exist 20 years ago.
It is dioxin passes through the body. It does damage and
alters the acids that serve as the on-off switches to the genes
which shows up as anomalies. So, you have five-year-olds having
heart attacks. You have three- and four-year-olds coming down
with a rare cancers and particularly the cancers that are
associated with exposure to Agent Orange.
The creation of a center for excellence on the already
existing VA format where all medical centers can compete and it
is based on what your organizational capability and how can you
add to this. But it would also create an Office of Extramural
Research.
We have had a real problem and the VA says that they do all
the research that is necessary. In fact, they do not do any
research on Gulf War Illness that is useful. They do not do any
research on Agent Orange that is useful, with the exception of
the National Vietnam Veterans Longitudinal Study which is due
to be delivered to the VA next month. They only did that after
Congress passed a law saying they had to and then we went
through 12 years of beating them over the head.
With the assistance of folks on the Hill, they finally
embarked on doing that study which will tell us a lot about
mortality and morbidity of Vietnam veterans.
But what we need is something that is multi- generational
that addresses the needs of Gulf War veterans, addresses the
needs of Vietnam veterans, affects burn pits, and the Camp
Lejeune. Any other toxic exposure which results in toxic wounds
to our Nation's veterans needs to go through the same, is
worthy of study and find out how do you treat these.
I am not going to get into the weeds on this now. In fact,
the veterans organizations are meeting tomorrow afternoon to
talk about it and see if we cannot come up with a united front
back to Senator Blumenthal with any changes to keep everybody
in the fold. But I think we are on the way to a really good
bill at markup.
I would suggest also that while we are in favor of most of
the bills that were on the agenda today, when it comes to the
health care record, on this one VA skirts are clean because DOD
has been blocking this process for twenty-some odd years.
What we have said and recommended to Secretary Hagel, who
we have enormous respect and affection for, is adopt VistA and
do it now and work together toward a common data warehouse both
for DOD and VA; and you have not only operability but you do
not have to translate anything. We need to develop that for VA
anyway.
When we brought this to Assistant Secretary of Health,
Assistant Secretary of Defense for Health, his comment was,
``it is cheaper for DOD to go a different way.'' I said it is
not cheaper for me as a taxpayer to go a different way. It is
going to be a heck of a lot cheaper to the taxpayer to do the
same system and make whatever improvements need to be made to
VistA together, and those improvements should include military
history.
I am 3 seconds over time, so I thank you for the
opportunity again and welcome any questions, Mr. Chairman.
[The prepared statement of Mr. Weidman follows:]
Prepared Statement of Submitted by Richard Weidman, Executive Director
for Policy and Government Affairs, Vietnam Veterans of America
Chairman Sanders, Ranking Member Burr, and other members of this
distinguished and important committee, Vietnam Veterans of America very
much appreciates the opportunity to offer our comments concerning
several bills affecting veterans that are up for your consideration.
Please know that VVA appreciates the efforts of this Committee for the
fine work you are doing on behalf of our Nation's veterans and their
families.
S. XXXX, introduced by Senator Richard Blumenthal (CT), would
establish in the Department of Veterans Affairs a national center for
the diagnosis, treatment, and research of health conditions of the
descendants of veterans exposed to toxic substances during service in
the Armed Forces, and to provide certain services to those descendants.
VVA strongly supports this bill, which reflects positively as one
of our foremost legislative goals. Not only would it help achieve a
measure of justice for innocent victims of the use toxic substances in
times of war, but it offers unlimited possibilities for scientific
investigation.
Among the so-called invisible wounds of war are those brought home
by troops that may not manifest for a decade or more. And most
tragically, they may pass on genetically to the children of our
Nation's warriors. And even to their children. We can only suspect,
citing some studies mostly from abroad. But this country has not done
enough research--has not wanted to fund enough research--into the
potential intergenerational effects of exposure to toxic substances.
Ask the VA how many studies its hundreds of scientists are conducting
in this realm. And the NIH. The CDC. Then ask yourselves, Why?
This legislation would also establish an Office of Extramural
Research, to award grants to reputable scientists and epidemiologists
to conduct research on wounds, illnesses, injuries, and other
conditions suffered by individuals as a result of exposure to toxic
substances while serving as members of the Armed Forces.
Perhaps most importantly, this legislation gives hope to the
progeny of warriors who are suffering from health conditions determined
by a board of advisors to have resulted from exposure to toxic
substances. Those selected for care and treatment, at no cost to them
and their caregivers, will be evaluated and treated at the designated
center.
Of all the bills before you here today, this is perhaps most
elemental to us. Because of our ongoing struggle with the unwanted
legacy of Agent Orange. And because of our empathy for veterans of the
first Gulf War with their still-undefined Gulf War illness, and for
veterans and active duty troops of the fighting in Afghanistan and Iraq
whose ingestion of fumes from burn pits will be their unwanted legacy.
We ask that you give your full consideration to this bill.
S. 1547, introduced by Senator Richard Burr (NC), the Veterans
Dialysis Pilot Program Review Act of 2013, would require the Secretary
of Veterans Affairs to review the dialysis pilot program implemented by
the VA and submit a report to Congress before expanding that program.
We understand that certain healthcare services are best performed
by clinicians outside of the VA. Dialysis is one of these. It seems,
however, that some folks in the VA are overeager to bring in-house
dialysis outpatient clinics into the fold, and have the go-ahead and
the dollars to start to do so.
The VA has identified the ``first wave'' of VA medical centers that
will receive first year startup funding to construct internal dialysis
capacity. Medical center directors have not been consulted and one VAMC
director has stated that his hospital center has no interest in
participating and does not wish to be in a position of having to fund
out year costs associated with creating internal dialysis capacity.
The already selected sites are largely in urban areas where private
sector dialysis capacity already exists. This means that veterans
living in rural America remain unaffected. And consider: In May of this
year, the VA awarded a national dialysis services contract to 23
private dialysis companies, both large and small, that provide full
geographic coverage to veterans across the country as well as providing
competitive rates in the range of Medicare. All VAMCs can utilize this
contract as of the 1st of October; hence, there are regional dialysis
contracts availaby to these medical centers and their community-based
outpatient clinics, or CBOCS.
So * * * Is it necessary for the VA to rush helter-skelter into a
questionable expenditure of capacity? Is this cost-effective? Or does
it make more sense to keep this as a service to be contracted out? At
the very least, any expansion of this program ought to be brought to a
halt until the results of the pilot program are compiled by the
Secretary and reported to Congress.
S. 1558, introduced by Senator Mark Begich (AK), the Veterans
Outreach Enhancement Act of 2013, would require the Secretary of
Veterans Affairs to carry out a program of outreach for veterans.
Under Secretary Shinseki's leadership, the VA is continuing to
pursue the most effective--if not necessarily coordinated--outreach
program since the end of the Second World War. While the Secretary and
others deserve credit for what they have done and are doing, there is
still much that needs to be done to educate veterans and their families
regarding the benefits and services they have earned in service to the
Nation.
With modest funding over a five-year period, this bill will help
fill a gap in rural America. We would suggest, however, that some of
the effort go to placing simple messages about key veterans benefits on
billboards in well-traveled areas. With this modest caveat, VVA
supports this measure.
S. 1296, introduced by Senator Bill Nelson (FL), the
Servicemember's Electronic Health Records Act of 2013, would amend the
Wounded Warrior Act to establish a specific timeline for the
Secretaries of Defense and Veterans Affairs to achieve interoperable
electronic health records.
Years ago, when the VA and DOD began this effort to achieve
interoperable electronic health records, both departments--their key
leaders and IT personnel--should have sat down together with members of
both the Senate and House Veterans' Affairs Committees and discussed
the projected timeline for completing this project--and the incumbent
problems likely to present along the way, e.g., what the costs would
amount to; how DOD would get its three services into line.
Finally, Senator Nelson is attempting to do all this with this
bill, which would achieve
(1) the creation of a health data authoritative source by the
Department of Defense and Department of Veterans Affairs that
can be accessed by multiple providers and standardizes the
input of new medical information is achieved not later than 180
days after the date of the enactment of this subsection;
(2) the ability of patients of both the Department of Defense
and the Department of Veterans Affairs to download the medical
records of the patient (commonly referred to as the `Blue
Button Initiative') is achieved not later than 180 days after
the date of the enactment of this subsection;
(3) the full interoperability of personal health care
information between the Departments is achieved not later than
one year after the date of the enactment of this subsection;
(4) the acceleration of the exchange of real-time data
between the Departments is achieved not later than one year
after the date of the enactment of this subsection;
(5) the upgrade of the graphical user interface to display a
joint common graphical user interface is achieved not later
than one year after the date of the enactment of this
subsection; and
(6) each current member of the Armed Forces and the dependent
of such a member may elect to receive an electronic copy of the
health care record of the individual beginning not later than
June 30, 2015.''
This is indeed admirable, and much needed, but perhaps not
realistic on two counts: First, considering the snail's pace of
progress seemingly made by the IT gurus of the two departments, the
timelines stipulated in this legislation is perhaps a bit unrealistic.
And second, without penalties and real enforcement, the due dates may
as well be written in sand.
S. 1295, introduced by Senator Sherrod Brown (OH), is a bill that
would require the VA Secretary to provide veterans with notice when
they electronically file claims for benefits that relevant services may
be available from veterans service organizations, and notify each
claimant or claimant representative that application services may be
available from veterans service organizations and provide such claimant
or representative with a list of such VSOs.
Far too many veterans submit claims for disability compensation
themselves. The assistance they receive from a VA employee amounts, for
the most part, to legal malfeasance if not malpractice. At VVA, we
advise any veteran who calls about a claim to get representation from a
veteran's service representative, from a VSO or from the county in
which s/he resides. Because they have been certified by the VA and they
know (at least they ought to know) how to cross the t's and dot the
i's. Hence, VVA strongly favors enactment of this measure.
S. 1148, introduced by Senator Martin Heinrich (NM), the Veterans
Benefits Claims Faster Filing Act, would direct the Secretary of
Veterans Affairs to post in a conspicuous place in each VA Regional
Office and claims intake facility and on the VA Web site information
on: (1) the average processing time for fully developed and not fully
developed VA benefits claims submitted in specified forms, and (2) the
percentage of such claims filed by specified methods for which benefits
are awarded. It also requires the Secretary to notify each person
submitting a claim for a VA benefit of such information and of the
person's eligibility to receive up to an extra year of benefit payments
if the person files a claim that is fully developed, and requires the
notice information to be updated at least quarterly.
Veterans of every generation can and do make good and rational
decisions when they have timely and accurate data to help inform their
decisionmaking. The requirements of this bill should have been realized
years before now in order for the VA to be in conformance with the
President's Executive Order(s) regarding open government and
accountability. In any case, VVA welcomes this initiative and supports
enactment of S. 1148.
S. 1211, introduced by Senator Barbara Boxer (CA), would prohibit
the use of the phrases ``GI Bill'' and ``Post-9/11 GI Bill'' to give a
false impression of approval or endorsement by the Department of
Veterans Affairs.
There are many legitimate not-for-profit and for-profit
institutions of higher learning that are committed helping their
students acquire a decent education and/or training that will be
immediately marketable. However, there are some predatory institutions
that have unscrupulously charged high tuitions from veterans, but
delivered little of value in return. While many of these ``colleges''
deceitfully attempt to appear to be accredited, they are in fact not
accredited by a reputable accreditation body. Therefore the ``degrees''
granted by these outfits are useless to the veteran, as their phony
degrees are not recognized by employers, legitimate colleges and
graduate school, or by state licensing bodies.
In many instances these same predatory institutions have used the
phrases GI Bill and Post-9/11 GI Bill in misleading advertisements to
try and make it appear as if they are sanctioned by the VA. The VA has
taken the first step, by registering the term ``GI Bill.'' And
enactment of this legislation should be helpful in limiting further
damage by these predators to our returning warriors.
Some would call these predators ``war profiteers'' in the ugliest
sense of that phrase. Others would label the behavior of these entities
and all of those who reap huge profits from them as ``stolen valor'' in
that they are robbing these post-9/11 veterans of the ability to
acquire a useful degree and marketable education and training. The only
thing wrong with this bill is that it does not go far enough. VVA
strongly favors early passage of this measure.
S. 1399, introduced by Senator Richard Durbin (IL), would amend the
Servicemembers Civil Relief Act to extend the interest rate limitation
on debt entered into during military service to debt incurred during
military service to consolidate or refinance student loans incurred
before military service.
This sensible bill would protect servicemembers by enabling them to
consolidate or refinancing earlier student loans and current loans at a
maximum 6% rate. This is a good deal for our men and women in uniform,
and should be passed by Congress with all due speed.
S. 1411, introduced by Senator Al Franken (MN), the Rural Veterans
Health Care Improvement Act of 2013, would specify requirements for the
next update of the current strategic plan for the Office of Rural
Health of the Department of Veterans Affairs for improving access to,
and the quality of, health care services for veterans in rural areas.
Because we have found that most ``strategic plans'' of the VA are
mostly a waste of trees, we in good faith cannot support S. 1411, even
though it embraces some very good ideas, e.g., the better use of
telemedicine.
It seems to us that the VA knows what it needs to do to improve
healthcare services to veterans living in rural and remote areas of
America. What it doesn't need is yet another ``plan'' that is dated
before it is printed to tell it what needs to be done.
S. 1155, introduced by Senator Jon Tester (MT), the Rural Veterans
Mental Health Care Improvement Act, would amend appropriations
authorities for veterans' benefits to provide advanced appropriations
for information technology relating to medical services, support,
compliance, and facilities of the Veterans Health Administration (VHA).
It would require the Secretary to provide mental health services,
including outpatient care, to the immediate families of certain
veterans returning from Operation Enduring Freedom or Operation Iraqi
Freedom. It would also require the Secretary to report to Congress
regarding telemedicine services for veterans, including updates on VA
teleconsultation and telemedicine initiatives, training, and
partnerships with primary care providers.
The VHA has made significant strides in the use of telehealth/
telemedicine, most usefully in rural and remote areas. While we hope,
and anticipate, that advance appropriations for all of the VA's
discretionary appropriations will be enacted during this session of
Congress, we do hope as well that Congress will see the wisdom of
expanding and improving the use of telemedicine services for veterans,
and so we certainly support passage of S. 1155.
S. 1262, introduced by Senator Bill Nelson (FL), the Veterans
Conservation Corps Act of 2013. This bill would:
(a) Establishment--The Secretary of Veterans Affairs shall, in
cooperation with the Attorney General, the Secretary of Agriculture,
the Secretary of Commerce, the Secretary of Homeland Security, the
Secretary of the Interior, and the Chief of Engineers, establish a
veterans conservation corps to assist veterans in the transition from
service in the Armed Forces to civilian life and to employ veterans--
(1) in conservation, resource management, and historic
preservation projects on public lands and maintenance and
improvement projects for cemeteries under the jurisdiction of
the National Cemetery Administration; and
(2) as firefighters, law enforcement officers, and disaster
relief personnel.
(b) Conservation, Resource Management, Historic Preservation, and
Cemetery Maintenance and Improvement Projects--
(1) In general--As part of the veteran's conservation corps,
the Secretary of Veterans Affairs, the Secretary of
Agriculture, the Secretary of Commerce, the Secretary of the
Interior, and the Chief of Engineers shall--
(A) employ veterans to carry out projects described
in subsection (a)(1); or
(B) award grants to, or enter into contracts with,
State governments, local governments, or
nongovernmental entities to employ veterans to carry
out projects described in subsection (a)(1).
The veterans who really need help with finding jobs are those 18-
24-year-olds and 25-29-year-olds, most of whom are with the National
Guard or Reserves, who have few marketable skills. (Veterans
unemployment rates are actually well under that of most other
Americans.) Such a program, the cost of a few days' operation in
Afghanistan, is certainly worth the price--and the futures of
potentially thousands of young men and women.
S. 1361, introduced by Senator Christopher S. Murphy (CT), World
War II Merchant Mariner Service Act, would direct the Secretary of
Homeland Security to accept additional documentation for verifying that
an individual performed honorable service as a coastwise merchant
seaman during the period beginning on December 7, 1941, and ending on
December 31, 1946, for purposes of eligibility for veterans' benefits
under the GI Bill Improvement Act of 1977.
The situation of those American citizens who served in these
potentially dangerous positions during World War II should have been
corrected many years ago. This historic wrong needs to be formally
righted. VVA has favored such legislation conferring full veteran
status on these individuals for almost thirty years, and now urges
swift passage of this measure before all of them are dead and gone.
S. 875, introduced by Senator Casey (PA), the Department of
Veterans Affairs Disease Reporting and Oversight Act of 2013, would
requires the director of a Veterans Integrated Service Network, within
24 hours after confirming the presence of a notifiable infectious
disease at a Department of Veterans Affairs (VA) facility under that
director's jurisdiction, to notify: (1) the Central Office of the VA;
(2) the Director of the Centers for Disease Control and Prevention; (3)
the state and county in which the facility is located; (4) each
individual at the facility who has contracted the disease or is at risk
of doing so, as well as the individual's next of kin, the individual's
primary health care provider, and the county in which the individual
resides; and (5) each VA employee of such facility. Requires such
director to comply with any earlier notification required by the state
concerned.
Requires such director to: (1) confirm receipt of such
notification, (2) develop and implement an action plan to manage and
control the potential spread of the disease, and (3) keep records of
any such notifications for at least 10 years. Requires an annual report
from the VA Inspector General to Congress on directors' compliance with
the requirements of this Act. Provides for Inspector General
enforcement and appropriate director disciplinary action with respect
to such requirements.
Directs the Under Secretary for Health of the Veterans Health
Administration (VHA) to issue a directive to the VHA's pathology team,
infection prevention team, facilities management team, and other
appropriate VHA groups on the actions to be taken when a notifiable
infectious disease is discovered in a VHA facility.
Inasmuch as almost everything in this bill is what common sense
would dictate in the event of an outbreak of a notifiable disease at a
VA medical facility, it would seem that this legislation would not ever
be needed. However, in the wake of the ``Legionella'' outbreak at the
VA Medical Center in Pittsburgh, Pennsylvania, and the subsequent lack
of proper and sensible steps being taken to notify either the community
or the VA hierarchy in a timely manner, this would seem to be a prudent
step for Congress to take. Although the situation was probably not as
badly handled as some outside of VA have portrayed it, the situation
was still not handled correctly.
VVA favors enactment of S. 875.
S. 1165, introduced by Senator Jon Tester (MT), the Access to
Appropriate Immunizations for Veterans Act of 2013, includes within
authorized preventive health services available to veterans through the
Department of Veterans Affairs immunizations against infectious
diseases, including each immunization on the recommended adult
immunization schedule established by the Advisory Committee on
Immunization Practices.
VVA strongly favors any additional mechanisms that promote better
accountability in the delivery of VA services, including immunizations,
and therefore endorses enactment of S. 1165.
S. 1281, Introduced by Senator Richard Blumenthal, (CT), Veterans
and Servicemembers Employment Rights and Housing Act of 2013, prohibits
employment practices that discriminate based on an individual's
military service and amends the Fair Housing Act and the Civil Rights
Act of 1968 to prohibit housing discrimination against members of the
uniformed services.
Declares that it shall be an unlawful employment practice for an
employer to fail to hire, to discharge, or to otherwise discriminate
against individuals because of their military service. Prohibits
employers, employment agencies, labor organizations, and job training
programs from engaging in specified practices that adversely affect an
applicant or employee because of such service.
Amends the Fair Housing Act to prohibit housing discrimination
against a member of the uniformed services with respect to: (1) the
sale or rental of housing, (2) residential real estate-related
transactions, and (3) the provision of brokerage services.
Amends the Civil Rights Act of 1968 to impose a fine, imprisonment,
or both on persons who violate prohibitions on housing discrimination
under such Act against members of the uniformed services.
VVA favors the provisions in this act. However, what is really
needed is enforcement of already existing statutes that bar such
behavior. Unless there is an effective means for timely and effective
redress for veterans who encounter such discrimination in employment or
housing, then all of the various laws will not matter in the lives of
veterans who become subject to such discrimination. Certainly the
Office of Federal Contract Compliance Programs and the Vietnam Era
Veteran Readjustment Act (VEVRA) is a classic example of good
intentions gone awry inasmuch as they have assisted less than 30
veterans in the last 40 years.
S. 1556, introduced by Senator Sherrod Brown (OH), would modify
authorities relating to the collective bargaining of certain employees
in the Veterans Health Administration.
Should a psychiatrist who works for the VA have the same rights
concerning ``grieving'' his or her schedule as a psychologist? Should a
registered nurse have the same rights as a licensed practical nurse?
Seems to us they should; according to the VA, they don't. Nor do
physicians, dentists, physician assistants, podiatrists, optometrists,
chiropractors, and certain dental auxiliaries. This personnel policy
seems schizoid, and without merit--and yet another reason why the VBA
has difficulty retaining top-shelf doctors and dentists and registered
nurses.
VVA supports fully the passage of S. 1556 because it strikes out
against indefensible bureaucratic curmudgeonliness, and for employee
justice.
S. 1559, introduced by Senator Richard Durbin (IL), the Benefits
Fairness for Filipino Veterans Act of 2013, would modify the method of
determining whether Filipino veterans are United States residents for
purposes of eligibility for receipt of the full-dollar rate of
compensation under the laws administered by the Secretary of Veterans
Affairs.
Is he or isn't he? Does he reside in the United States, thereby
earning him top-dollar compensation for his wartime service, or does he
really reside in the Philippines? Enactment of this legislation, one
would hope, would help clarify the situations of a number of Filipinos
who served under the U.S. flag during the Second World War, and VVA
supports its enactment.
S. XXXX, introduced by Senator Bernard Sanders (VT), would update
the Service-Disabled Insurance program to base premium rates on the
Commissioners 2001 Standard Ordinary Mortality able instead of the
Commissioners 1941 Standard Ordinary Table of Mortality.
Gee, progress! VVA of course supports this effort by the Chairman
to bring a modicum of rationality to this program.
S. XXXX, introduced by Senator Bernard Sanders (VT), would provide
replacement automobiles for certain disabled veterans and members of
the Armed Forces.
A measure of this ilk has been needed for some time, especially in
those areas of the Nation where public transportation is spotty or non-
existent. Hence, VVA supports this bill.
s. xxxx, introduced by senator bernard sanders (vt), the veterans
health care eligibility expansion and enhancement act of 2013.
This bill would open the VA healthcare system to all eligible
veterans, meaning all veterans who meet certain criteria and who have
received other than a dishonorable discharge. As long as a mechanism to
gradually admit veterans is written into regulation so as not to
overwhelm the system, VVA wholeheartedly supports this measure. Nor do
we believe that the healthcare system will be overloaded inasmuch as
most veterans who are able to afford private insurance under ACA or
through the entity for which they work will likely prefer to go to
their own medical and dental professionals.
s. xxxx, introduced by senator bernard sanders (vt), the enhanced
dental care for veterans act of 2013.
Several studies have shown that poor dental health contributes to
and in fact leads to deterioration of the overall physical and mental
health. This being so, the case is compelling to add dental care to the
package of benefits to patients at VA healthcare facilities who are not
100 percent service-connected disabled. This is hardly a luxury;
rather, it is a vital element of an overall wellness program that the
VA claims is a goal for all of its patients. We believe that an
econometric study would show that it costs less to provide reasonable
dental care than it does to treat the ravages that poor teeth wreak on
the health of veterans, particularly low-income veterans.
The VHA has made headway in this arena, offering all of its
patients the opportunity to purchase dental insurance at seemingly
reasonable rates. This, however, will not help the poorest veterans who
have neglected their dental health for too long.
VVA fully support enactment of this legislation.
s. xxxx, introduced by senator bernard sanders (vt), the mental health
support for veteran families and caregivers act of 2013.
It seems to us that in order to help a veteran who has Post-
traumatic Stress Disorder or Traumatic Brain Injury, especially chronic
PTSD or TBI, family members and caregivers need support and assistance
if efforts of the VA are to have any chance of success at even
mitigating these issues and helping the veteran achieve a decent
quality of living. Assuming that this bill will help achieve some
degree of success in this area, VVA supports its enactment as a step in
the right direction.
S. XXXX, introduced by Senator Bernard Sanders (VT), the Survivors
of Military Sexual Assault and Domestic Abuse Act of 2013, would
provide counseling and treatment for sexual trauma to members of the
Armed Forces; require the Secretary to screen veterans for domestic
abuse; and require the Secretary to submit reports on Military Sexual
Trauma (MST) and domestic abuse.
Considering the somewhat belated attention being paid to MST, this
bill takes a rather proactive approach to assisting veterans who have
been victimized by abuse. In the arena of domestic abuse, however, the
bill may be going a bit too far for the veterans' own good by
``develop[ing] and implement[ing] a screening mechanism to be used when
a veteran seeks healthcare services * * * to detect if the veteran has
been a victim of domestic abuse for purposes of improving the treatment
of the veterans and assessing the prevalence of domestic abuse in the
veteran population.''
Either way, VVA endorses enactment of this legislation.
S. XXXX, introduced by Senator Jon Tester (MT), would provide for
the payment of temporary compensation to a surviving spouse of a
veteran upon the death of the veteran.
How can anyone not be in favor of such legislation? We have heard
of far too many instances in which a veteran dies, leaving his spouse
just this side of destitute. To provide the VA with the means to pay
temporary compensation to assist her, or him, in this difficult time is
more than fitting. It is simply the right thing to do.
VVA supports this measure.
Again, on behalf of our membership, we thank you for the
opportunity to present our testimony before this Committee, and we
thank all of you for the work you are doing on behalf of our Nation's
veterans and our families.
Chairman Sanders. Thank you very much, Mr. Weidman.
Let me just start off and ask each of you very briefly. All
of your organizations have people who access the VA health care
system. What are you hearing? Is it a good system? Mr. Atizado.
I am murdering your name here and I apologize for that.
Mr. Atizado. Adrian is fine.
Chairman Sanders. Adrian, all right. That I can handle.
Mr. Atizado. I believe so, Mr. Chairman, generally. As an
advocacy organization the things we hear about are the same
things that a lot of Members on this Committee and the staff
probably hear as well are just complaints.
But, you know, the type of complaints that we get really
are more about implementing policy and not the quality of care.
To that end, those that we do have the opportunity to speak
with that are patients in our organization love the VA. They
will defend it and they are very strong advocates, vocal
advocates, also very vocal critics when it needs to be. I think
that is the overall perspective our members have about VA
health care.
Chairman Sanders. Colonel Norton.
Colonel Norton. Thank you, Mr. Chairman.
You know the VA that Rick and I experienced coming back
from Vietnam 40 plus years ago compared with today is light
years different. I mean, it is by many different measures,
studies, et cetera, has a markable record of safety and
quality.
Sure, more needs to be done. I would say that information
outreach and access is an issue especially for veterans that do
not understand or know that they may be eligible to enroll in
VA health care.
Chairman Sanders. Mr. Weidman.
Mr. Weidman. Overall it is an excellent system. On special
needs of vets, particularly neuropsychiatric, spinal cord
injury, amputations and prostheses--they are ahead of most
American medicine.
So, we think it is an excellent system. We strongly favor
your bills opening it up and including dental care in that.
Chairman Sanders. Well, let me pick up on that, Mr.
Weidman.
Do you bump into Vietnam vets who would like to access VA
health care but are ineligible to do so?
Mr. Weidman. I do, sir.
Chairman Sanders. And do you think opening up the system
would give them the opportunity to access good quality health
care?
Mr. Weidman. I think it would if they know about it. I
cannot tell you the number of people who do not--even going to
the VA Web site, if you look up diabetes in the patient library
you want to know more about diabetes, it does not mention a
darn thing about Agent Orange.
Chairman Sanders. Well, you have raised an issue dear to my
own heart. We have had at least one hearing on that issue
already and we are going to do more. I think if you go to the
Web site, it is a better Web site today than it was a year ago.
Mr. Weidman. Absolutely.
Chairman Sanders. You are seeing ads on television and on
the radio which are pretty good. So, I think these guys are
trying to get their act together. Not everybody, you know, not
every veteran wants to use the VA and that is fine. But I think
our job is to make sure that every veteran in America knows
what he or she is entitled to so if they do want to use the
system they can come in.
So, I agree with you that outreach remains an issue and it
is an issue that this Committee is going to continue to work
on.
Adrian, what do you think? Are there folks out there who
would like to access VA but are ineligible and do not know
about the system?
Mr. Atizado. I am pretty sure there are, Mr. Chairman, yes.
Chairman Sanders. So, one of the things that we want to do
is to expand VA eligibility and bring more veterans into what
we consider to be a strong and cost-effective system.
Any of you want to comment on dental care or am I the only
person in the world obsessed by this issue?
Mr. Atizado. I will gladly do it, and I will echo my
comments with Mr. Weidman. Dental care is a longstanding issue
for DAV. As you mentioned and was mentioned by other folks,
including Dr. Jessie behind me, it is a critical part of health
care.
For whatever reason, there are parts of VA's medical
benefit package that has not caught up with what we believe
health care to be today, whether it is certain parts of long-
term care and in this particular case dental care. So, we are
very supportive of that bill. We would like to see it get into
the fold of the medical benefit package, yes.
Chairman Sanders. Colonel.
Colonel Norton. Thank you, Mr. Chairman.
The reality is that the view that dental health and
physical health are distinct and different aspects of treating
the human person is old thinking. It is obsolete.
The reality is that you can have severe dental health
issues that affect your overall health. I would add that we
have had the experience early in the last decade when tens of
thousands of members of the Reserves were called up that became
compounded when they came back and became veterans.
Many of them had teeth pulled. They did not get proper care
from DOD. They really just had to get them deployed into the
combat zone and so they did not provide proper dental health
care.
Now, that is being visited really on the VA system now that
many of them are applying for health care access there.
Chairman Sanders. Mr. Weidman.
Mr. Weidman. Dental care is, in fact, part of health care.
We met with the VA dentists numerous times. There have been
many studies that we have reviewed about it being key to
maintenance of overall wellness.
The people who you do not take care of who do not have the
ability themselves to pay for dental care are going to end up
at VA because they are going to be indigent and so sick that
they get in. Why not see them before they get that sick?
I also want to mention something. Years ago when I was
chairman of the board of PAVE in Vermont, we had a smart
counselor in St. Johnsbury, and he had a client who stayed
drunk all the time, and he could not get him to go to the
hospital, could not do anything. His wife had thrown him out,
et cetera.
He figured out that the key was the guy had no teeth. So,
he said I do not know what to do. CEDA will not pay for it. So,
I went to a friend who was a classmate at Colgate who was a
dentist in Stowe and he had been instrumental in starting the
ToothFairy Program.
He said, do you have somebody in St. J who will do it if we
buy the materials. The board of PAVE, all Vietnam vets, chipped
in to buy the materials. We got the guy a new set of choppers,
got him down to White River Junction to Matt Freedman and
turned him around on the PTSD and the alcohol. We got him a
job, and his wife took him back and that was his story.
The barrier to employment could be anything but in this
case it was his health and it was his teeth. That was the key
to his overall well-being.
Chairman Sanders. Excellent point.
Senator Burr.
Senator Burr. Thank you, Mr. Chairman.
Let me start by thanking all of your organizations for
their support for the Camp Lejeune water contamination issue.
Rick, as you know, it is a very long process to go through.
The whole study of water toxicity--we have made more progress
in the last 2 years than we have in the past 20 years, and I
hope that there is a blueprint that we create through that for
other toxic exposures that may exist.
Let me also ditto what you said about the electronic
medical records being a DOD problem and not a VA problem. As
one person's opinion who has been in the debate on this side of
the dais, I have always seen a willingness on the part of VA
and expertise on the part of the VA and I have seen nothing but
reluctance and pull back on the part of DOD.
And I say that to my colleagues that are on the Armed
Services Committee. I do not think it is a lack of willingness
on the VA side. It is clearly a lack of willingness on the part
of the DOD, and I hope we can close that gap.
If I could pray for any IT explosion at the VA, it would be
for a new appointment program that would actually walk somebody
through to where a veteran could actually access all their
doctors in one visit versus the multiple visits that it takes
today.
I think that is a difficult thing to explain that it cannot
be done and it is not because of the lack of money. We have
spent a tremendous amount of money only to have a failure
again.
Colonel Norton, in your testimony regarding my bill, the
Improving Quality of Care Within the Department of Veterans
Affair Act of 2013, you stated this, ``Directives from VA
central office can take significant periods of time to be
reviewed by local facilities and then not implemented as
originally intended.''
What do you believe are those bottlenecks?
Colonel Norton. I think this gets back to what Adrian said
earlier, that there is a culture of individuality out there in
the VISNs that even though the central office might issue a
particular directive or policy, the way that it is implemented
turns into a completely local affair. It has to do with the
leadership there and the responsiveness of that local system to
VA central.
It is an elaborate problem and I think your bill is needed
in order to address a more outside systematic look at an
efficient way to run the railroad, if you will.
Senator Burr. Our hope is to structurally put some
accountability into the system.
Rick, in your testimony regarding my dialysis bill,
S. 1547, you stated that dialysis is one of those services best
performed by clinicians outside of VA. However, as you stated
in your testimony, some folks in the VA are overeager to bring
dialysis outpatient clinics into the fold.
Why, in your opinion, is VA overeager?
Mr. Weidman. It is not just on this issue. The contracting
out makes sense where veterans have to travel great distances.
Even in some States--we do not usually think of North Carolina
as rural like parts of the rest of the country.
Senator Burr. Only 80 percent of it is.
Mr. Weidman. Right. But for those in the rural areas--it is
really rural when you get out west. The point is that in those
areas to contract out makes a great deal of sense for all the
reasons that Senator Johanns talked about earlier, where there
are quality facilities out there you can contract with.
But to contract out where there is dialysis already
existing in urban areas makes no sense to us unless you can
show it is amazingly more cost-effective for VA to develop its
own dialysis unit. The capital costs in developing a dialysis
unit and keeping it staffed properly and up to date, I think
you could do much more easily outside.
Senator Burr. Well, let me just say I have challenged Dr.
Jesse to present the sales pitch to me of why this should be
done internally.
I will take my 53 seconds that I have got to editorialize a
little bit. In addition to the wishes of the Chair to expand
access to the VA, we cannot lose focus on the fact that over
the next decade we will have probably 500,000 individuals who
separate from the military and who are eligible in some way,
shape, or form for VA.
In my State of North Carolina, we are not in a position
today to physically handle what we currently have just from
military retirees who are moving to North Carolina and VA
eligible. This is not a secret. The VA recognizes that too.
If we begin construction today, I am not sure that we could
ever meet the needs of all who will migrate there as retirees
and those that will separate from the military and name North
Carolina has home.
Given the fact that we cannot do that and there are going
to be continuing pressures on the need for additional
facilities, personally, and I say this, Dr. Jesse, and I hope
you hear it, I am not sure why we would waste the capital to
create something that seems to work fairly well on a contract
basis because we are going to need that capital to stand up
delivery points for the delivery of care where there is no
expertise or availability outside of VA.
Chairman Sanders and I have talked about ways that we might
be able to leverage the federally qualified community health
centers in a way that we can actually put a VA presence closer
to where veterans live.
You know, if you have to put a VA sign over a door and put
a new door in or have dual services that are operated by the x-
ray machine and copy machine and a nurse, even if you have to
have two separate physicians, our ability to do that because
our objective here--which I do not think it is at odds with the
VA's objective--is to keep veterans healthy, to keep them out
of our hospitals, to do as much things in outpatient facilities
as we can.
It means the expansion of things like HCCs with ambulatory
outpatient surgery centers. It means some degree of partnership
with community health care centers for any overnight
observation.
But I hope that the veterans service organizations and the
Members on this side do not lose perspective on the fact that
the demands in dollars over the next 10 years for the
infrastructure needs to handle the population that we have made
a promise to are huge.
Today, we have $14 billion worth of construction either let
or underway and we have no idea how we are going to finish
paying for that much less this horizon that we see that we know
is coming. We cannot deny it. We have got to be responsive to
it.
So, mine is not a judgment based upon trying to tell the VA
what they should and should not do. It is to some degree facing
the realities of what we have before us and asking how we can
best allocate our funds and leverage our dollars in a way that
fulfills the promise that we have made to all those
individuals.
So, I thank the Chair for the editorial time.
Chairman Sanders. Thank you, very much, Senator Burr.
Senator Blumenthal.
Senator Blumenthal. Thank you, Mr. Chairman.
Let me begin by saying that I agree with much of what
Senator Burr has just said about the challenges that we need to
face and have not prepared to confront going forward simply in
the numbers that will separate from the military.
I see it from the standpoint of the Committee on Armed
Services where we are preparing for the downsizing of our
military in numbers that are almost unprecedented in recent
history.
Obviously in the wake of every war, we have downsized to
some extent but this influx of needs--health care requirements
as well as other kinds of challenges and obligations that we
owe--they are not new obligations.
We have made promises and the Nation needs to keep faith
with them. So, I welcome his statement and I know that the
Chairman has spoken to it as well. But I hope that we can come
together as a Committee again on a bipartisan basis and try to
at least produce a blueprint for trying to deal with these
issues.
Mr. Weidman, I want to say a personal thanks to you and to
the Vietnam Veterans of America who have been absolutely
instrumental and central in developing the Topic Exposure
Research and Military Family Support Act of 2013, and I welcome
additional changes after you consult with other organizations,
including the DAV, and Colonel Norton, with your organization
as well.
I have no pride of authorship in this bill. I have no
preconceived notion of what should be in it but I think the
central point is we have an obligation to provide remedies to
diseases and conditions that have been passed on to children
and grandchildren, as you have so eloquently said, Mr. Weidman,
and also to veterans, more recent veterans from Afghanistan
exposed to the burn pits, the members of families at Camp
Lejeune that Senator Burr and Senator Hagan have championed.
This issue of toxic chemicals is just beginning to be
understood. The fact that we expose our military men and women
to these wounds of war without any real scientific knowledge
and awareness or sensitivity to those issues I think is a gap
that we need to remedy.
So, I think you are performing an enormous service, your
organization and others, in calling attention to this very,
very difficult and challenging area.
Without being too long-winded, I also want to second your
point about VistA and the Department of Defense.
As long as the folks from the VA are still here, I join
Senator Burr in raising some qualms about the reaction of the
Department of Defense. I think I alluded to those qualms
earlier.
But let me just ask you if I may, Mr. Weidman, about the
Toxic Exposure Research and Military Family Support Act. I have
had one of these roundtables in Connecticut. You were kind
enough to join us.
Is there a national constituency for this bill in your
view?
Mr. Weidman. There is, Senator, and we have had since that
roundtable at Rocky Hill, CT, 20 some odd meetings. There were
seven just the week before last and in the same week in Florida
in a round robin format, been to California; and I think that
by next spring, certainly by Memorial Day, that you will have
one in virtually every State in the union, at least one.
Frankly, our goal is to have one in every congressional
district so people cannot say it does not affect my veterans
because it sure as heck does because the exposures were so
wide, when you looked at what happened to Gulf War one,
Vietnam, and the young people serving today.
Senator Blumenthal. Thank you. My time has expired but I
again want to thank each of you for being here today for your
service to our Nation and for the service that has been
provided to every single member of the organizations you
represent.
Thank you so much.
Thank you, Mr. Chairman.
Chairman Sanders. Thank you, Senator Blumenthal.
Let me thank the panelists and again reiterate what Senator
Blumenthal said, we thank you very much for the work of your
organizations. This Committee cannot do its job without
learning and working with all of the service organizations.
I want to thank VA for being here as well and for their
excellent testimony. I think it has been a good hearing and I
thank everyone for attending.
This hearing is adjourned.
[Whereupon, at 4:25 p.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Senator John D. Rockefeller IV,
U.S. Senator from West Virginia
Mr. Chairman, thank you for holding this important hearing. The
legislation being discussed today covers a wide range of important
issues that will help us fulfill our solemn promises to our veterans,
our servicemembers, and our military families.
I appreciate the opportunity to discuss the SCRA Enhancement and
Improvement Act of 2013, which I proudly introduced this week with
Chairman Sanders. The Servicemembers Civil Relief Act was first passed
in 1940 as the Soldiers' and Sailors' Civil Relief Act (SSCRA), and it
was designed to help make sure that that servicemembers' sacrifices for
our Nation did not force them to also sacrifice their credit and their
financial well-being. In the decades since, the law became known as the
Servicemembers Civil Relief Act and has been amended several times.
This law goes far to assist servicemembers in a wide range of areas
including protecting them from foreclosure, default judgments, and
eviction. However, the Department of Justice and experts in this field
have pointed to common-sense changes we can make to clarify and expand
the protections that exist today. In making these changes, the law will
match our intent, and make sure that common areas where military
service affects servicemembers' finances and rights are not overlooked.
Among other things, the improvements in our bill will protect
servicemembers from being discriminated against when being considered
for a loan simply because of their entitlement to rights under the
SCRA; strengthen some of the foreclosure protections under existing
law; and give servicemembers extra time to renew their professional
licenses and meet continuing education requirements if they are
deployed.
I have always been proud of this Committee's ability to work in a
bipartisan fashion for the best interests of our veterans and military
families. I hope this will again be the case with this legislation so
we can give servicemembers critical help they earned and deserve.
______
Letter from Hon. Frank B. Aguon, Jr., Chairman, Committee on Guam
U.S. Military Relocation
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of the American Federation of Government Employees,
AFL-CIO and the AFGE National Veterans' Affairs Council
American Federation of Government Employees and the AFGE National
Veterans' Affairs Council (hereinafter ``AFGE'') appreciate this
opportunity to provide a statement for the record on S. 1556, a bill to
restore equal bargaining rights to health care professionals at
Department of Veterans (VA) Affairs medical facilities.
AFGE represents 650,000 Federal employees. More than two thirds of
the 210,000 VA employees we represent work on the front lines at VA
medical facilities caring for veterans.
S. 1556 provides a long overdue fix to a gross inequity in the law
that weakens the VA's ability to attract and maintain a strong health
care workforce. The law in question--38 U.S.C. 7422 (``Section
7422'')--also deprives veterans of full protection from improper and
unsafe care. Earlier this year, a VA registered nurse and AFGE local
president testified before Congress about the cover up and mishandling
of a deadly Legionnaires outbreak at her facility. Yet, if a registered
nurse (RN) at her facility attempted to file a grievance over excessive
mandatory overtime that deprived her of adequate rest and put her
patients at risk, her grievance would be blocked by current VA ``7422''
policy.
Section 7422 unfairly singles out VA employees in eight health care
positions: registered nurses (RN), physicians, dentists, physician
assistants, optometrists, podiatrists, chiropractors and expanded-
function dental auxiliaries. AFGE also represents RNs, physicians and
others working in these covered positions at facilities operated by the
Department of Defense (DOD) and the Bureau of Prisons (BOP). These DOD
and BOP employees are permitted to grieve over routine workplace issues
such as the assignment of mandatory overtime and calculations of shift
differential pay because they are covered by Title 5 bargaining rights,
like most Federal employees.
The VA's``7422'' policy also results in differential treatment
between VA health care professionals working at the same facility. VA
Hybrid Title 38 employees have full Title 5 bargaining rights. The
result is extremely arbitrary: a VA registered nurse cannot bargain
over the failure to provide adequate training when she is reassigned
from primary care to the ICU while a VA licensed practical nurse can.
Similarly, a VA psychiatrist cannot grieve over the loss of incentive
pay while a VA psychologist can.
Opponents have argued that S. 1556 creates new bargaining rights.
This is not correct: S. 1556 merely restores equal bargaining rights
that were afforded to these clinicians prior to 2003. Unfortunately,
over the past decade, the VA adopted a different interpretation of
Section 7422 to deprive these clinicians of rights to grieve and
negotiate over routine workplace matters and block complaints arising
out of violations of rights under other Federal laws.
Opponents have claimed that if VA physicians and RNs (and those in
the other six covered positions) have full bargaining rights, it will
interfere with management's mission to provide patient care. Yet, VA
management does not claim that VA Hybrid 38 employees interfere with
patient care when they exercise full bargaining rights.
In fact, VA physicians, RNs, and other Title 38 clinicians working
at the Captain James A. Lovell Federal Health Care Center in North
Chicago already have full bargaining rights under Public Law 110-417.
In 2010, when the Navy and VA merged facilities at this location, the
law provided that all the DOD clinicians who became VA Title 38
employees would retain their full bargaining rights as VA employees
under a pilot project for two years. To date, the VA has not made a
single complaint about the impact of full bargaining rights on patient
care at the Lovell Federal Health Care Center. In fact, recently, the
VA extended that pilot project for an additional three years.
Title 5 affords VA management the same rights as all Federal
managers to carry out the agency's mission, including the right to
determine the number of employees, hire, assign, suspend and remove
employees, and ``to take whatever actions may be necessary to carry out
the agency mission during emergencies'' (5 U.S.C. 7106(a)).
Several years ago, AFGE participated in good faith in a VA working
group that culminated in new VA ``7422'' policy. AFGE did not sign the
Memorandum of Understanding that formed the basis of the new policy
because it did not accurately reflect the language adopted by the
working group. Although the new policy is a step in the right
direction, it is a very small step that does not have the force of law.
It can be revoked at any time, which is exactly what President Bush did
in 2003 when he nullified a very helpful labor-management agreement
reached seven years earlier.
AFGE and its National VA Council are also troubled by the VA's
continued practice of refusing to bargain over matters that are covered
by the new ``7422'' policy, and the continued practice of local human
resources personnel trying to make their own ``7422'' determinations,
even though the law clearly states that only the Secretary can make
those determinations.
Finally, too many VA Title 38 clinicians are experiencing first
hand that ``justice delayed is justice denied.'' The Secretary has only
published four ``7422'' determinations since the new policy took effect
in 2010. The Department has still not responded to AFGE's August 2013
information request to determine how many cases are pending. These
backlogged cases involve real employees with serious workplace issues
that need to be addressed.
Thank you again for the opportunity to present the views of AFGE
and its National VA Council on S. 1556.
______
Prepared Statement of Anthony A. Wallis, Legislative Director,
Association of the United States Navy (AUSN)
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Letter from Wendy Spencer, Chief Executive Officer, Corporation for
National and Community Service
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of Keith Kelly, Assistant Secretary of Labor For
Veterans' Employment and Training, U.S. Department of Labor
introduction
Chairman Sanders, Ranking Member Burr, and distinguished Members of
the Committee. Thank you for the opportunity to provide the Department
of Labor's (DOL or Department) views on pending legislation. I commend
you all for your tireless efforts to ensure that America fulfills its
obligations to our returning servicemembers, veterans, and their
families. The Department looks forward to working with the Committee to
provide these brave men and women with the employment support,
assistance and opportunities they deserve to succeed in the civilian
workforce.
While this hearing is focused on numerous bills pending before the
Committee, I will limit my remarks to those pieces of legislation that
have a direct impact on the programs administered by DOL, including the
following: S. 1262, the ``Veterans Conservation Corps Act of 2013,''
S. 1281, the ``Veterans and Servicemembers Employment Rights and
Housing Act of 2013,'' and S. 1558, the ``Veterans Outreach Enhancement
Act of 2013.'' DOL respectfully defers to other Federal Departments or
Agencies with respect to the remaining pieces of legislation.
s. 1262--``veterans conservation corps act of 2013''
S. 1262, the ``Veterans Conservation Corps Act of 2013'' would
establish a ``Veterans Conservation Corps,'' similar to the Civilian
Conservation Corps, aimed at employing veterans: (1) in conservation,
recreation, and resource management projects on public lands, and (2)
as firefighters, law enforcement officers and disaster relief
personnel. The Veterans Conservation Corps would be administered by the
Department of Veterans Affairs (VA) in cooperation with the Departments
of Justice (DOJ), Agriculture, Commerce, Homeland Security, Interior,
and the Army Corps of Engineers.
DOL supports the intent of this bill, which includes similar
concepts to the Administration's Veterans Job Corps proposal that was
presented in its FY 2014 Budget. We would welcome the opportunity to
work with the Committee on this bill.
s. 1281--``veterans and servicemembers employment rights and
housing act of 2013
S. 1281, the ``Veterans and Servicemembers Employment Rights and
Housing Act of 2013'' would prohibit discrimination in employment and
housing on the basis of military service. The Department supports the
intent of this legislation, but defers to the Equal Employment
Opportunity Commission (EEOC), DOJ, and the Department of Housing and
Urban Development (HUD) on sections of the bill that fall outside the
Department's purview. We do, however, have some technical concerns with
section 2 of the bill, as drafted, and look forward to working with the
Committee to address these concerns and enhance employment protections
for veterans and members of the Armed Services, Guard and Reserve.
DOL administers and enforces a number of laws that protect American
workers and ensure that they are treated fairly on the job. Among these
important worker protections are the Uniformed Services Employment and
Reemployment Rights Act of 1994 (USERRA), Section 4212 of the Vietnam
Era Veterans' Readjustment Assistance Act (VEVRAA) and the provisions
relating to veterans preference in Federal employment under Title 5 of
the U.S. Code. Through USERRA and other laws, DOL works tirelessly to
ensure that the men and women who serve this Nation are protected
against adverse discrimination based on their past, present, or future
military service obligations.
The Department has concerns with how section 2, which is modeled
after Title VII of the Civil Rights Act of 1964, would interact with
the Department's existing authorities that protect against
discriminatory employment actions. In our view, this could be confusing
for both claimants and employers, and could yield inconsistent results.
The Department gladly would work with the Committee, and our fellow
agencies, to ensure that the important aims of S. 1281 are achieved
without adversely impacting existing protections.
s. 1558--``veterans outreach enhancement act of 2013''
DOL defers to the VA on the substance of the legislation, but has a
technical concern with the provision on outreach activities related to
USERRA. More specifically, in section 2, paragraph (d)(2)(D), the
Secretary of Veterans' Affairs is given authority ``to enter into
agreements with other Federal and State agencies to carry out projects
under the jurisdiction of such agencies'' to ``educate communities and
State and local governments about the employment rights of veterans,
including the employment and reemployment of members of the uniformed
services under chapter 43 of title 38, United States Code.'' Due to the
highly complex and technical nature of USERRA, DOL is concerned about
ensuring consistency in any educational outreach program. DOL therefore
believes that the bill should be amended to require that any applicable
outreach be conducted in coordination with the Department.
conclusion
The Department of Labor is committed to providing our veterans,
transitioning servicemembers, and their families with the best possible
employment services, protections, and programs our Nation has to offer.
Mr. Chairman, Ranking Member Burr, and Members of the Committee--this
concludes my statement. Thank you again for the opportunity to submit
this statement for the record.
______
Prepared Statement of Bryan Greene, Acting Assistant Secretary for the
Office of Fair Housing and Equal Opportunity, Department of Housing and
Urban Development
Chairman Sanders, Ranking Member Burr, and Members of the
Committee, I am pleased to have this opportunity, on behalf of the U.S.
Department of Housing and Urban Development (HUD), to discuss S. 1281,
the Veterans and Servicemembers Employment Rights and Housing Act of
2013. S. 1281 proposes to protect Veterans and Servicemembers from
housing discrimination, by making certain amendments to the Fair
Housing Act (hereafter Housing Act, or Act). The Office of Fair Housing
and Equal Opportunity, of which I am the Acting Assistant Secretary,
has the primary responsibility for enforcing and administering the
Housing Act. We strive to prevent discrimination through outreach and
education, but when housing discrimination occurs we do not hesitate to
take enforcement action against those that violate the law.
Each year my office, and our state and local partners investigate
more than 8,000 complaints of housing discrimination based on race,
color, religion, sex, national origin, familial status, and disability.
Far too many of these cases involve veterans--often, they are veterans
who encounter discrimination based on injuries that they sustained
during their service. In one case, a Vietnam veteran alleged his
housing complex denied him permission to have his companion dog live
with him, which he needed because of a disability. Following an
investigation, the Department negotiated a conciliation agreement,
whereby the owner and apartment management company agreed to pay
$10,000 to the veteran. In another case, HUD charged a Utah homeowners
association for allegedly discriminating against a Gulf War combat
veteran with psychiatric disabilities when it refused his request to
keep an emotional support dog. In February 2012, the Justice Department
obtained a settlement with the homeowner association that awarded the
veteran $20,000 and required the homeowner association to implement a
new reasonable accommodation policy and train its staff on the
requirements of the Housing Act. Other cases have included allegations
of refusing to make reasonable accommodations for veterans with Post
Traumatic Stress Disorder (PTSD) or refusing to rent to a veteran
because of PTSD.
Currently, the Housing Act does not prohibit discrimination based
specifically on veteran or military or veteran status, and as such, HUD
brought all the foregoing cases on the basis of the Act's current
prohibitions against ``disability'' discrimination. As such, we do not
have a definitive or comprehensive count of discrimination on the basis
of veteran or military status. However, under the Department's Fair
Housing Assistance Program, HUD partners with 95 State and local
agencies that administer fair housing laws that are substantially
equivalent to the Act, and five state agencies and eight local agencies
in the program administer laws that include protections for
servicemembers and veterans. Through the program, the agency is able to
provide civil-rights protections for just those servicemembers and
veterans living in those jurisdictions.
The Housing Act is a national civil rights statute that provides
protections based on race, color, religion, sex national origin,
familial status, and disability. There have been a number of proposals
in recent years to amend the Act, to make it unlawful to discriminate
on the basis of sexual orientation, gender identity, marital status,
and source of income. We believe that further study should be given to
ascertain how best to address these issues.
HUD agrees that members of our military who risk their lives
overseas should not encounter obstacles related their military service
as they search for a home upon their return. We would be happy to work
with our State and local partners that currently provide these
protections to gather information on the frequency of this
discrimination and to provide any assistance with can to assist the
Committee in crafting the best way to combat this kind of
discrimination.
______
Prepared Statement of Iraq & Afghanistan Veterans of America
------------------------------------------------------------------------
Bill # Bill Name Sponsor Position
------------------------------------------------------------------------
S.875 Department of VA Disease Reporting & Casey Support
Oversight Act
------------------------------------------------------------------------
S.1148 Veterans Benefits Claims Faster Heinrich Support
Filing Act
------------------------------------------------------------------------
S.1155 Rural Veterans Mental Health Care Tester Support
Improvement Act
------------------------------------------------------------------------
S.1165 Access to Appropriate Immunizations Tester Support
for Veterans Act
------------------------------------------------------------------------
S.1211 A bill to prohibit the use of Boxer Support w/
phrases GI Bill and Post-9/11 GI Conditions
Bill to give a false impression of
approval...
------------------------------------------------------------------------
S.1216 Improving Job Opportunities for Bennet Support
Veterans Act
------------------------------------------------------------------------
S.1262 Veterans Conservation Corps Act Nelson Support
------------------------------------------------------------------------
S.1281 Veterans and Servicemembers Blumenthal No Position
Employment Rights and Housing Act
------------------------------------------------------------------------
S.1295 A bill to require the Secretary to Brown Support
provide notice that relevant
services may be available from VSOs
------------------------------------------------------------------------
S.1296 Servicemember's Electronic Health Nelson Support
Records Act
------------------------------------------------------------------------
S.1361 World War II Merchant Mariner Murphy No Position
Service Act
------------------------------------------------------------------------
S.1399 A bill to amend the SCRA to extend Durbin Support
the interest rate limitation on
debt entered into during military
service...
------------------------------------------------------------------------
S.1411 Rural Veterans Health Care Franken Support
Improvement Act
------------------------------------------------------------------------
S.1434 A bill to designate the Junction Moran No Position
City CBOC as the LTG Richard J.
Seitz Community-Based Outpatient
Clinic
------------------------------------------------------------------------
S.1471 Alicia Dawn Koehl Respect for Nat'l Coats Support
Cemeteries Act
------------------------------------------------------------------------
S.1540 A bill to include contracts and Brown Support
grants for residential care for
veterans in the exception...
------------------------------------------------------------------------
S.1547 Veterans Dialysis Pilot Program Burr No position
Review Act
------------------------------------------------------------------------
S.1556 A bill to modify authorities Brown No Position
relating to the collective
bargaining of employees in the VHA
------------------------------------------------------------------------
S.1558 Veterans Outreach Enhancement Act Begich Support
------------------------------------------------------------------------
S.1559 Benefits Fairness for Filipino Durbin No Position
Veterans Act
------------------------------------------------------------------------
S.1573 The Military Family Relief Act Tester Support
------------------------------------------------------------------------
Draft 1 A bill to update the Service- Sanders Support
Disabled Insurance program to base
premiums rates...
------------------------------------------------------------------------
Draft 2 A bill to provide replacement Sanders No Position
automobiles for certain disabled
veterans and members of the Armed
Forces
------------------------------------------------------------------------
Draft 3 Veterans Health Care Eligibility Sanders No Position
Expansion and Enhancement Act
------------------------------------------------------------------------
Draft 4 Enhanced Dental Care for Veterans Sanders Support
Act
------------------------------------------------------------------------
Draft 5 Mental Health Support for Veteran Sanders Support
Families and Caregivers Act
------------------------------------------------------------------------
Draft 6 Medical Foster Home Act Sanders Support
------------------------------------------------------------------------
Draft 7 SCRA Enhancement and Improvement Act Sanders No Position
------------------------------------------------------------------------
Draft 8 Improved Compensation for Hearing Sanders Support
Loss Act
------------------------------------------------------------------------
Draft 9 Survivors of Military Sexual Assault Sanders Support
and Domestic Abuse Act
------------------------------------------------------------------------
Draft Toxic Exposure Research and Military Blumenthal No Position
10 Family Support Act of 2013
------------------------------------------------------------------------
Draft A bill to expand eligibility for Hirono Support
11 reimbursement for emergency medical
treatment to certain veterans ...
------------------------------------------------------------------------
Draft The Improving Quality of Care Within Burr Support
12 the Department of Veterans Affairs
Act
------------------------------------------------------------------------
Chairman Sanders, Ranking Member Burr, and Distinguished Members of
the Committee: On behalf of Iraq and Afghanistan Veterans of America
(IAVA), I would like to extend our gratitude for the opportunity to
share with you our views, thoughts, concerns and recommendations
regarding these important pieces of legislation.
IAVA is the Nation's first and largest nonprofit, nonpartisan
organization for veterans of the wars in Iraq and Afghanistan and their
supporters. Founded in 2004, our mission is critically important but
simple--to improve the lives of Iraq and Afghanistan veterans and their
families. With a steadily growing base of nearly 270,000 members and
supporters, we strive to help create a society that honors and supports
veterans of all generations.
In partnership with other Veteran Service Organizations (VSO), IAVA
has worked tirelessly to see that veterans' needs and concerns are
appropriately addressed by the Department of Veterans Affairs (VA) and
by Congress. IAVA appreciates the efforts put forth by this Committee
to address the issues and challenges facing our Nation's veterans and
their families. We stand with you in supporting legislation to continue
improving the services offered by VA, empowering veterans to improve
their lives after military service, and ensuring that veterans are
fully aware of all the benefits available to them as our Nation begins
transitioning away from more than a decade of war in Iraq and
Afghanistan.
IAVA is, therefore, able to offer its support for many of the bills
that are the subject of this hearing today because we believe that they
would better enable the VA to live up to its commitment on behalf of
the American people.
s. 875
IAVA supports S. 875, the Department of Veterans Affairs Disease
Reporting and Oversight Act, which would require directors of Veterans
Integrated Service Networks (VISNs) to report confirmed cases of
certain infectious diseases at Veterans Health Administration (VHA)
facilities. In addition, plans to prevent the spread of infectious
diseases must be established and implemented following the notification
of infection.
As currently written, Title 38 does not contain obligatory
reporting requirements for infectious diseases. The need for
established reporting and prevention protocols is clear following
numerous infectious disease deaths at several VA medical facilities
over the past year. In response to these deaths, the VA has released
VHA Directive 2013-008, which requires VA medical facilities to follow
state laws on reporting infectious diseases similar to those that
private and non-profit medical centers must follow. But it is also
important for Congress to codify such reporting requirements.
This legislation seeks to include a list of agencies, personnel,
and employees that are required to be notified within 24 hours when
certain infectious diseases are confirmed at a VA medical facility.
IAVA believes that responsible reporting of such occurrences and
outbreaks and a comprehensive plan to prevent the spread of such
diseases is an essential aspect of preventing future unnecessary
deaths.
s. 1148
IAVA supports S. 1148, the Veterans Benefits Claims Faster Filing
Act, which would require the Secretary of Veterans Affairs to provide
and post information, both at VA facilities and on the Internet,
regarding average claims processing times and the percentages of claims
filed via each of the various claims intake methods.
In order to help facilitate the transition to a 21st century VA,
IAVA supports utilizing electronic processes for more efficient claims
processing and information dissemination. Educating veterans on the
most efficient filing methods will help streamline the claims process
and assist the VA in reducing the claims backlog. This legislation aims
to establish prominent public displays about the differences in types
of claims-filing pathways in order to ensure that all veterans are
making informed decisions regarding the claims filing process. IAVA
supports this bill because it will provide veterans with more
information on the claims process and will help veterans make an
informed decision about how to best file their claims.
s. 1155
IAVA supports S. 1155, the Rural Veterans Mental Health Care
Improvement Act, which would provide advance appropriations for
specific information technology accounts within the VA, include
education and training for additional types of therapists and
counselors, expand the definition of mental health services, and
require the VA to report on the status of telemedicine services.
The need for advance appropriations for additional aspects of the
VA was clear during the most recent government shutdown. Not only were
veterans left wondering when the services they need would resume, but
VA employees were also left to wonder when they could return to work
and training. In today's technology-dependent world, the need for an
adequately funded and functioning information technology infrastructure
is obvious, and providing advanced appropriations for this aspect of
the VA's operations is vital to helping the department continue to
function during future shutdowns. IAVA believes that advance
appropriations for all VA accounts is necessary, but this legislation
would at least ensure that additional aspects of VA's infrastructure
could continue operating in spite of the political environment.
IAVA also supports educating and training additional mental health
professionals and counselors to meet the various needs of veterans and
their families. Specifically, this bill would include training and
education for marriage and family therapists as well as licensed
professional mental health counselors. Well-trained mental health
professionals and counselors provide quality counseling options for
veterans in need of these services, and educational opportunities for
these professionals at the VA should be expanded.
Additionally, this bill would require the Secretary of Veterans
Affairs to report on issues currently hindering the provision or
expansion of telehealth services by the VA. Since telehealth services
rely heavily on technology, the implementation of such services
presents some challenges for rural veterans. The report would include
the scope of challenges the VA is experiencing and what the VA is doing
to address these challenges. IAVA supports understanding these
challenges and establishing methods to address them so that better
health care options will be available for all veterans regardless of
location.
s. 1165
IAVA supports S. 1165, the Access to Appropriate Immunizations for
Veterans Act of 2013, which would expand what immunizations are covered
by the VA. This legislation seeks to include all immunizations listed
on the adult immunization schedule published by the Center for Disease
Control and Prevention (CDC).
As currently written, Title 38 allows for immunization coverage,
but does not specify which immunizations will and will not be covered
within its section on definitions. This bill aims to utilize the CDC's
dynamically updated immunization schedule to develop a uniform standard
of the immunizations that will be covered by the VA. The CDC's schedule
for immunizations is already used by healthcare professionals and
insurance agencies to determine when and which immunizations are
recommended. IAVA supports the use of the CDC's immunization schedule
for the VA as well in order to remove the ambiguity on covered
immunizations currently in Title 38.
s. 1211
IAVA supports the intent of S. 1211, a bill which would prohibit
the use of the phrases ``GI Bill'' and ``Post-9/11 GI Bill'' by any
company, organization, or individual as it relates to promotions,
goods, services, or commercial activity so as to give a false sense of
approval or endorsement by the VA without the written consent of the
Secretary of Veterans Affairs.
IAVA recognizes the need to safeguard veterans against fraudulent
and misleading services, goods, and promotions in regards to the GI
Bill and Post-9/11 GI Bill educational benefits. However, it is unclear
to IAVA if whether VSOs, other non-profit organizations, and useful
projects and initiatives such as IAVA's NewGIbill.org would also be
prohibited from utilizing the phrases ``GI Bill'' and ``Post-9/11 GI
Bill'' without approval. IAVA feels the bills current language is too
exclusionary, and we encourage the Committee to address these concerns.
s. 1216
IAVA supports S. 1216, the Improving Job Opportunities for Veterans
Act of 2013, which would improve and increase on-the-job training
programs and apprenticeship opportunities for veterans in the private
sector and in the Federal Government.
The transition from the military to the civilian workforce
continues to be a struggle for many veterans. Creating opportunities
for veterans to learn new civilian skills through on-the-job training
and apprenticeships would help create an even stronger veteran
workforce. This legislation would create training opportunities that
veterans need, and IAVA supports the continued effort to help veterans
successfully transition to civilian careers.
s. 1262
IAVA supports S. 1262, the Veterans Conservation Corps Act of 2013,
which would create a Veterans Conservation Corps to employ veterans in
conservation, historic preservation, resource management, National
Cemetery Administration projects, and as fire fighters, law enforcement
personnel, and disaster relief personnel.
Too often veterans leave military service and face difficulty
securing civilian careers. Recent reports from the Bureau of Labor
Statistics show the post-9/11 veteran unemployment rate to be 10.1%,
and the unemployment rate among veterans aged 18-24 is an alarming
22.8%. Reducing these percentages is a priority for IAVA, and we
support legislation to directly address veteran unemployment. While
there are programs in existence to assist veterans in transition, a
Veterans Conservation Corps would go one step further by creating more
opportunities to continue to serve. IAVA supports this legislation
because it would help veterans develop skills that can be used for
continued civilian careers.
s. 1281
IAVA has no position on S. 1281, the Veterans and Servicemembers
Employment Rights and Housing Act of 2013. Although IAVA strongly
supports the fair and equitable treatment of veterans, at this time
IAVA has no organizational position on this legislation.
s. 1295
IAVA supports S. 1295, which would require the VA to post
information about the services and assistance available from VSOs so
that veterans who file electronic claims will be more aware of the
services available to help them in applying for benefits.
VSOs have well established programs to assist veterans with
submitting claims, but veterans are not always aware of these services.
Therefore, they do not always avail themselves of such services. IAVA
supports this bill because it takes advantage of a key engagement
opportunity with veterans to inform them of outside services that they
may find helpful.
s. 1296
IAVA supports S. 1296, the Sericemembers' Electronic Health Records
Act, which would establish a timeline for the implementation of
interoperable electronic heath records.
Interoperability between the Department of Defense (DOD) and VA
medical records systems is a key component in establishing a smooth
transition for veterans from DOD health care to VA health Care. IAVA
supports the establishment of a reasonable timeframe for making
implementing this mandate.
s. 1361
IAVA takes no position on S. 1361, which would designate those who
served as Merchant Mariners during WWII as veterans for the purpose of
providing these individuals and their family members with access to
certain benefits afforded to veterans. While we understand and
acknowledge that there is an ongoing debate within the veteran
community about whether to bestow veteran status and benefits on other
categories of individuals who served our Nation in various capacities
during previous periods of conflict, we defer to that debate and to our
colleague veteran and military service organizations--whose memberships
and constituencies this would impact more--on this issue.
s. 1399
IAVA supports S. 1399, which would amend the Servicemembers Civil
Relief Act (SCRA) to allow pre-service private or Federal student loan
debt to be refinanced or consolidated while retaining the 6% rate cap
afforded under SCRA.
In order to qualify for the Public Service Loan Forgiveness
Program, servicemembers with a Federal education loan or a Perkins
student loan must consolidate their pre-military service loans. The
forgiveness program rewards borrowers who have made regular payments
for ten years while in public service, including service in the
military. Specific language in SCRA shields servicemembers from costly
interest rates by capping their interest rates at 6% on loans that were
initiated prior to their military service. Should a servicemember
choose to refinance his or her student loan, that individual would no
longer be eligible for the interest rate cap afforded under SCRA.
This legislation would fix this loophole by allowing student loan
debt accrued prior to military service to be consolidated or refinanced
while maintaining the 6% interest rate cap offered on pre-service debts
through SCRA. This change effectively allows servicemembers with a
Perkins loan or other Federal education loans to enter into the Public
Service Loan Forgiveness Program, and thus better manage their personal
finances.
s. 1411
IAVA supports S. 1411, the Rural Veterans Health Care Improvement
Act of 2013, which would improve access to and quality of health care
services for veterans in rural areas.
A significant number of our Nation's veterans seeking access to VA
health care live in rural areas, yet these areas lack some of the
typical medical facilities to which many other veterans living in more
densely populated areas have easier access. Even though community-based
outpatient clinics seek to provide more convenient health care access
for rural veterans, these men and women are still not always getting
the treatment and access tailored to their particular medical needs.
This bill would seek to ensure that rural veterans' access to
health care is significantly improved by requiring VA to produce a
five-year strategic plan that demonstrates how VA will recruit and
retain health care professionals in rural areas, how VA will ensure the
successful and timely delivery of its services through contract and
fee-basis providers, and also how it will implement and expand the use
of telemedicine services in rural areas.
s. 1434
IAVA has no position on S. 1434, a bill that would designate the
Junction City Community-Based Outpatient Clinic in Junction City,
Kansas as the Lieutenant General Richard J. Seitz Community-Based
Outpatient Clinic. As a standard practice, IAVA typically does not take
a position on bills whose sole purpose is to designate or name
facilities. However, IAVA fully supports efforts to honor
servicemembers and veterans who have had exemplary careers, have
accomplished outstanding achievements, and/or have made extraordinary
sacrifices for our country.
s. 1471
IAVA supports S. 1471, the Alicia Dawn Koehl Respect for National
Cemeteries Act, which would give the VA the authority to disinter
veterans buried in national cemeteries that committed of a Federal or
state capital crime.
In 2012, Michael Anderson, an Army veteran, shot and killed Alicia
Dawn Koehl before committing suicide as the police were arriving. After
discovering that Mr. Anderson was buried with full military honors at a
national cemetery in Michigan, the Koehl family requested that Mr.
Anderson's remains be exhumed, since Federal law prohibits those who
have committed a capital crime but were unavailable for trial due to
death from being given the honor of a burial in a national cemetery.
Upon review, the VA determined that it does not have the legal
authority to disinter a veteran. Therefore, this legislation is needed
in order to give the VA this authority and rectify this problem.
IAVA believes that the Koehl family's wish ought to be
legislatively enabled in order to bring this family closure and a sense
of justice and to ensure that the VA is not stuck in this situation
again in the future. Individuals who commit heinous capital crimes
against their fellow citizens do not warrant a resting place on the
same hallowed ground as our Nation's most honored heroes.
s. 1540
IAVA supports S. 1540, a bill which would make state homeless
facilities eligible for more Federal grants. Federal law allows state
veterans homes to operate under three categories (domiciliary care,
nursing home care, or hospital care). Because state veterans homes are
not permitted to receive other Federal funds, they are not eligible for
grants under VA's Health Care for Homeless Veterans Program. In order
to more effectively address veteran homelessness, veterans homeless
shelters should be afforded greater flexibility to receive such
funding, which this bill seeks to achieve.
s. 1547
At this point in time, IAVA has no position on S. 1547, a bill that
would require VA to ensure that it's dialysis pilot program is not
expanded until it has been implemented at its initial facilities, an
independent analysis of the program has been conducted, and VA has
provided a report to Congress detailing progress of the program.
s. 1556
At this point in time, IAVA has no position on S. 1556, a bill
which would address the collective bargaining rights of employees at
the Veterans Health Administration (VHA). Although IAVA strongly
supports the recruitment and retention of quality VA employees, it has
no organizational position on this legislation.
s. 1558
IAVA supports S. 1558, the Veterans Outreach Enhancement Act of
2013, which would require the VA to partner with local veterans
organizations in an effort improve outreach to veterans in certain
areas of the country.
Too many men and women leaving the military are not enrolling in
the VA and are failing to utilize the care and services they need.
Currently, the burden is largely on these veterans to acquire
information access their benefits. Expansion and enhancement of VA's
outreach at the state and local levels is necessary in order to provide
these veterans with key information about the services, programs, and
benefits available to them in order to ensure that they are taking full
advantage of everything VA has to offer. This bill will also provide
states and local veterans organizations with grants in an effort to
incentivize improvements in outreach to local veteran populations.
Fully bringing America's newest generation of veterans into the VA
will require an unprecedented outreach effort, and the Veterans
Outreach Enhancement Act of 2013 is the first step in getting us there.
s. 1559
At this point in time, IAVA has no position on S. 1559, the
Benefits Fairness for Filipino Veterans Act of 2013, which would
address residency requirements for certain veterans of World War II. As
always, IAVA is incredibly humbled by and appreciative of the service
and patriotism of those who fought for our country in a time of war
across all generation.
s. 1573
IAVA supports S. 1573, the Military Family Relief Act, which would
automatically provide temporary compensation to a surviving spouse of a
veteran upon the death of the veteran.
As this Committee is fully aware, filing a claim with the VA can
become a lengthy ordeal and can leave servicemembers, veterans, and
their family members waiting in anguish for a response of some kind. In
order to ensure that the bereaved family members of deceased
servicemembers and veterans are not forced to endure any more anguish,
the Veterans Benefits Administration (VBA) should be given the ability
to provide dependency and indemnity compensation (DIC) and other
related benefits to the family automatically, instead of being forced
by law to cutoff the disability pay and pension upon the veteran's
death and requiring the surviving spouse to re-file. This cumbersome
and unnecessary step adds more hardship to spouses at a difficult time
in their lives, and efforts to ensure that these individuals are
compensated with ease is an objective that IAVA supports.
draft bill 1 (sen. sanders)
IAVA supports this draft legislation, which would base Service-
Disabled Veteran Insurance premium rates on the Commissioners 2001
Standard Ordinary Table of Mortality as opposed to the Commissioners
1942 Standard Ordinary Table of Mortality.
The Commissioners Standard Ordinary Tables of Morality (CSO) are
used to calculate life insurance non-forfeiture values and are also
used by the VA to calculate premiums for the Service-Disabled Veteran
Insurance program available to veterans with a service-connected
disability. As currently written in Title 38, the VA utilizes a CSO
from 1941, which provides antiquated numbers to calculate life
insurance premiums and non-forfeiture costs. IAVA supports this bill to
update the CSO to the 2001 version in order to arrive at more accurate
and updated estimates of life insurance non-forfeiture costs and
premiums.
draft bill 2 (sen. sanders)
At this point in time, IAVA has no position on this draft
legislation, which would provide replacement automobiles for certain
disabled veterans and servicemembers under certain specific
circumstances. IAVA has been a proponent of streamlining the
regulations and processes for veterans and servicemembers receiving
care and assistance from the VA. However, we are still reviewing this
newly drafted legislation and look forward to finding out more about
how the changes it makes would improve the lives and livelihoods of
veterans.
draft bill 3 (sen. sanders)
At this time, IAVA has no position on the Veterans Health Care
Eligibility Expansion and Enhancement Act of 2013, which would require
VA to provide for the enrollment of certain veterans who otherwise do
not have access to health insurance while also expanding eligibility
for veterans to enroll in VA health care.
The VA should be the primary one-stop shop for the services and
benefits that veterans have earned. Providing quality care for veterans
of Iraq and Afghanistan requires an innovative approach that address
both the mental and physical health of a veteran. We must continue to
expand efforts to connect more veterans to vital health care resources,
however IAVA would prefer to further analyze this legislation in order
to better provide this Committee with our thoughts and views about
proposed reforms dealing with changes to whether veterans qualify for
treatment as low-income families, as well as the contracts VA enters
into for the purposes of rendering health care services.
draft bill 4 (sen. sanders)
IAVA supports the draft bill entitled the Enhanced Dental Care for
Veterans Act, which would extend allowable dental services to veterans
who are hospitalized or in a nursing home, who have previously received
dental services, and who need those services to restore functioning
lost as a result of the previous dental services. Additionally, this
bill would establish educational programs on dental health and
establish a means for private sector dental providers to supply the VA
with relevant dental records to be included in patient electronic
medical records, when necessary. IAVA supports increasing dental
coverage provided to veterans in the care of the VA and supports the
educational programs in conjunction with this dental care to help
veterans understand how to maintain dental health and is, therefore,
able to support this legislation.
draft bill 5 (sen. sanders)
IAVA supports the draft bill entitled the Mental Health Support for
Veteran Families and Caregivers Act, which would establish education
and peer support programs for family members and caregivers of veterans
with mental health disorders.
These programs would help family members and caregivers learn best
practices for providing care to veterans with mental health disorders,
including general education on mental health disorders, techniques for
handling crisis situations, and information on additional services.
Training and education on handling crisis situations for family members
and caregivers could help in addressing the the suicide and crisis
situations that too many veterans experience. In conjunction with the
educational programs, peer support groups would also be established to
provide family members and caregivers a network of support. Providing
daily care for a veteran experiencing mental health disorders can bring
stress upon the family and caregivers, and IAVA supports providing
resources and a safe outlet for coping with this stress.
draft bill 6 (sen. sanders)
IAVA supports the draft bill entitled the Medical Foster Home Act,
which would allow the VA to cover the costs associated with care at a
medical foster home.
Medical foster homes are a long-term health care option for
veterans and provide access to trained caregivers in a residential
setting. The VA does not currently provide or pay for medical foster
homes, but it does regularly inspect, approve, and refer veterans to
such facilities. The needs of veterans vary greatly, and medical foster
homes provide additional health care options for veterans who may be
uncomfortable in other long term care settings.
draft bill 7 (sen. sanders)
At this point in time, IAVA has no position on the SCRA Enhancement
and Improvement Act, which would improve and update several aspects of
the Servicemembers Civil Relief Act (SCRA). IAVA has certainly been a
proponent of protecting servicemembers from undue civil and financial
burdens caused by military service. However, we are still reviewing the
specific enhancements and improvements to the SCRA referred to in this
bill and look forward to finding out more about these potential
changes.
draft bill 8 (sen. sanders)
IAVA supports the Improved Compensation for Hearing Loss Act, which
would require the Secretary of Veterans Affairs to submit reports on
the findings and actions taken to address a 2006 Institute of Medicine
and the National Academies report on hearing loss and tinnitus caused
by military service. Since hearing loss and tinnitus remain a frequent
problem for veterans, a better statistical understanding of these
issues will help establish best practices for addressing these types of
disabilities. This bill would also require reports detailing the level
of cooperation between the DOD and VA on hearing loss, and ways in
which the two can cooperate in the future. IAVA supports cooperation
and continuity between DOD and VA health care, and hopes to see
continued cooperation in the future.
draft bill 9 (sen. sanders)
IAVA supports the Survivors of Military Sexual Assault and Domestic
Abuse Act, which would allow VA to provide counseling and treatment for
sexual trauma to members of the Armed Forces, require VA to screen
veterans for domestic abuse, and require VA to submit reports on
military sexual trauma and domestic abuse.
Sexual assaults in the military have increasingly become a high-
profile issue; in 2012, according to a Pentagon report, an estimated
26,000 servicemembers experienced unwanted sexual contact, 7,000 more
than in 2010. In an effort to ensure that all victims of military
sexual trauma have adequate care and counseling available to them, this
legislation expands VA's coverage to include active duty servicemembers
as well as members of the National Guard and Reserves. This legislation
will not require a servicemember to obtain a referral before receiving
care and counseling, a provision that would provide victims with easier
access to such critical care and counseling.
The bill would also require VA to develop a screening mechanism for
veterans seeking VA health care to determine if any of these
individuals have been victims of domestic abuse. Given the high
likelihood that instances of domestic abuse are significantly
underreported, proactive screening for such abuse is an initiative that
IAVA stands behind.
draft bill 10 (sen. blumenthal)
At this time, IAVA has no position on the Toxic Exposure Research
and Military Family Support Act of 2013, which would establish a VA
medical center as the national center for appropriately dealing with
the health conditions of descendants of servicemembers exposed to toxic
substances.
The lasting effects of exposure to toxic substances are yet to be
fully documented and without data tracking the health and well-being of
deployed servicemembers and their families, it will be more difficult
to in the long term to treat the dependents who are suffering because
of their family member's exposure. Veterans of the wars in Iraq and
Afghanistan are not the only ones who have fought to see VA recognize
and provide compensation for exposure to toxic substances during
overseas deployments. Vietnam veterans long complained about the
effects of Agent Orange exposure and were only recently granted VA
disability benefits based on the diseases they contracted because of
it. Likewise, Gulf War veterans have fought for decades for recognition
of and reimbursement for the multiple maladies that make up Gulf War
illness.
The VA has already acknowledged that there is a link between some
birth defects in children with a parent that was exposed to certain
toxic substances. This bill would seek to ensure that family members
have the necessary facilities already identified and appropriately
staffed to handle the medical needs of those whose ailments can be
traced to their family member's exposure to toxic substances. IAVA will
continue to review and analyze the Toxic Exposure Research and Military
Family Support Act in order to better provide this Committee with its
thoughts and views about establishing a national center focused on
research, treatment, and diagnosis of illnesses that manifest in the
descendants of those exposed to toxic substances.
draft bill 11 (sen. hirono)
IAVA supports this draft legislation, which would expand
eligibility for reimbursement for emergency medical treatment to
certain veterans that were unable to receive care from VA in the 24-
month period before the emergency care was administered.
As currently written, VA requires veterans to meet a specific and
cumbersome eligibility requirement in order to ensure that they will
cover the expenses a veteran accrues when receiving emergency medical
treatment at a non-VA facility. This eligibility criteria indicates
that veterans must not only have been enrolled in the VA health care
system, but that they must have been seen by a VA health care
professional within the last 24 months. Since veterans are often
subjected to lengthy wait times that prevent them from obtaining an
initial appointment sooner rather than later, veterans' claims for
reimbursement would be denied.
By providing an exception to the 24-month requirement, this
legislation would provide veterans with a level of financial certainty
and peace of mind at a point in time when they should be solely focused
on seeking medical assistance. IAVA believes veterans should not have
their financial stability adversely impacted by an outdated requirement
and by lengthy wait times for appointments.
draft bill 12 (sen. burr)
IAVA supports the Improving Quality of Care Within the Department
of Veterans Affairs Act of 2013, which would require VA to ensure its
policy on reporting cases of infectious diseases is current and up-to-
date and would require an independent assessment of the Veterans
Integrated Service Networks (VISN) and VA medical centers.
Following the deaths of five veterans across several in the VA
medical centers in Pennsylvania due to an outbreak of legionnaires'
disease, subsequent reporting has indicated that a lack of
communication and coordination--along with VA officials' failure to
follow internal policies--allowed the disease to spread, leaving
veterans and their family members in the dark about the extent of the
outbreak. This legislation would require VA to ensure that it has an
up-to-date policy on reporting infectious diseases in accordance with
state and local laws. VA will also be required to craft performance
measures to ensure that VISN officials are complying with the updated
policy. Finally, an independent third-party will conduct its own
oversight to scrutinize VA medical centers, planning amongst VISN
officials, and other standard business operations to ensure that VA is
providing quality health care.
VA officials need to prove to veterans, Congress, and the public
that their ability to render care is unquestionable, and the oversight
authored in this legislation seeks to achieve that aim.
Mr. Chairman, we at IAVA again appreciate the opportunity to offer
our views on these important pieces of legislation, and we look forward
to continuing to work with each of you, your staff, and the Committee
to improve the lives of veterans and their families.
Thank you for your time and attention.
______
Prepared Statement of Infectious Diseases Society of America
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Letter from J. Don Horton, President, WW II Coastwise Merchant Mariners
in support of
s. 1361 ww ii merchant mariners service act
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Letter Submitted by Paul J. Koehl & Family in Support of
S. 1471, The Alicia Dawn Respect for National Cemeteries Act
Indianapolis, IN, October 15, 2013.
U.S. Senate,
Washington, DC.
Dear Senators,
It has happened again! Despite the best efforts of Senator Barbara
Mikulski and Senator Larry Craig in 2006 and 2007 to enact a law
ensuring that those veterans who commit capital crimes not be afforded
the privilege of burial with military honors in the hallowed grounds of
our National cemeteries, the injustice continues.
My name is Paul J. Koehl of Indianapolis, IN. I am a 45 year old
father of two children, Victoria 13 and Thomas 12. In May 2012, I
became a widower. Mere words cannot begin to describe the feelings of
loss, loneliness, and grief my children and I experience on a daily
basis. Only someone who has dealt with the inexplicably brutal slaying
of a loving spouse could possibly understand.
On May 30, 2012, my dear wife and loving mother of our two
children, Alicia Dawn Koehl, was mercilessly gunned down as she sat at
her desk during a mass shooting at the Indianapolis apartment complex
where she was newly employed as an assistant sales manager. Alicia was
shot an unthinkable 13 times by an angry tenant whom she had never met.
She died at the scene. After shooting Alicia and three other
individuals, the shooter committed suicide with a single self-inflicted
gunshot to the head after being confronted by the police. Loaded clips
of ammunition in the killer's possession indicate that the shooting
spree was far from over had the police not arrived so quickly and acted
so bravely. The killer was U.S. Army veteran, Michael Lashawn Anderson.
Needless to say, the hearts and lives of my children and I, as well as
those of my entire family, continue to be haunted by the senseless acts
of violence carried out by Michael Lashawn Anderson on that day.
My beloved wife of 16 years, Alicia Dawn, was the glue that held
our family together. She was an extremely warm and giving member of the
community as well. Being an extraordinarily kind and loving wife and
mother, she was a faithful member of St. Pius Catholic Church,
``Volunteer of the Year'' and PTO president at Spring Mill Elementary
where our children attended school, an excellent amateur photographer,
and devoted Girl Scout leader. Her smile and gentle nature never failed
to light up a room. One of her coworkers, a shooting victim himself,
was quoted as saying, ``In the few weeks since Alicia started working
here, she made it a pleasure to come to work.'' She always put the
needs of others before her own. Often her ``me'' time was spent
contributing time and effort to charitable activities, often utilizing
time with her girlfriends to participate in events such as the Mud Run.
For those of you not familiar, this is a combination obstacle course,
human steeple chase event held in a mud bog for the sole purpose of
raising funds and awareness for the Susan G. Komen Foundation's Race
for the Cure.
Alicia's life revolved around our family. Her near expert photos
line the walls and her motto ``Live, Laugh, Love'' appears in nearly
every room in our home. She loved sports and her role as a sports mom,
encouraging our daughter Victoria at gymnastics competitions and our
son Thomas at hockey tournaments. She was even known to schedule the
time we attended church on Sunday based upon kickoff time of that day's
Indianapolis Colts football game. She would always say she couldn't
wait to watch the Colts with Thomas, Victoria, Daddy, and Harley (the
family dog).
A candlelight vigil organized by family friends and the staff of
Spring Mill Elementary School was held on the Friday following her
death. School Principal Sabha Balagopal said of Alicia `` She had a
zest for life. Her sense of humor and laughter lifted our spirits and
made our PTO meetings so much fun.'' A friend and co-worker said `` I
don't understand why the people who die are always the brightest
lights.'' At the June 4th session of the Indianapolis City/County
Council, a motion to ``close the meeting in recognition, respect, and
appreciation for the life and contributions of Alicia Dawn Koehl'' was
made by Councilor Scales and is now forever a part of the permanent
record. Council President, Maggie Lewis added, ``America has been made
great by those persons who have made landmark contributions, as well as
those whose very presence in the community is a stabilizing influence
which lends a sense of purpose and direction.'' That was my Alicia.
Unbeknownst to us, at the same time we were laying my Alicia to
rest, her killer was ``mistakenly'' being given a military burial at
Fort Custer National Cemetery in Battle Creek, Michigan in direct
violation of 38 U.S.C. 2411. We were informed of this injustice several
weeks later when a family friend Googled Anderson's name. It turned out
that not only had Anderson committed this heinous crime in
Indianapolis, he also had pending charges and a criminal record in his
home state of Michigan. Prior to Anderson's military burial, no one
bothered to check these easily accessed facts, or if they did, they
chose to ignore them. Adding further insult, both Alicia's father and
Brother served in the United States Marine Corps. Her father, Sgt.
Ronald Lunte was a bronze star decorated veteran of two tours in
Vietnam. Imagine how the revelation that their daughter's murderer had
received a military burial must have felt in the Lunte household.
We have made every effort to go through all of the proper channels
in our effort to get this injustice resolved. We have contacted the
Fort Custer Cemetery personnel, The Indianapolis Mayor's Veteran
Affairs Liaison, and finally the Office of Veteran Affairs in
Washington D.C. in an attempt to have Alicia's killers remains removed
from Fort Custer National Cemetery. Our requests moved slowly through
VA channels eventually arriving at the desks of Undersecretary Steve
Muro and Secretary Eric K. Shinseki, both in the office of Veterans
Affairs. Even a direct appeal to Secretary Shinseki, personally
delivered by a family friend, West Point graduate, Airborne Infantry
Commander, and veteran of two tours of duty in Vietnam was not enough
to move those in positions of authority to correct their error.
In late July of this year, the VA and their lawyers assumed the
stance that they ``lacked the authority'' to reverse the illegal burial
of Michael Lashawn Anderson. Passage of the Alicia Dawn Respect for
National Cemeteries Act will provide the Department of the Army and the
Veterans Affairs Office with the explicit authority they say they lack.
This will give them not only the authority to ``do the right thing''
and correct this latest outrage, but also give them the tools they need
to prevent similar painful events from occurring in the future.
Generally, our family holds our Nations veterans in the highest
regard and have been regular contributors to the Disabled Veterans of
Indiana, however, when a veteran such as Michael Anderson commits a
Capital crime, he strips himself of this honor and should summarily
forfeit any and all benefits bestowed upon honorable veterans,
including the benefit of a military burial. It does a great disservice
to all of our Nations veterans when a murderer like Michael Anderson is
allowed to be interred in a place of honor alongside men and women who
have given of themselves for the protection of all that this Nation
holds dear, and lived their post service lives as upstanding members of
our communities.
Perhaps our West Point/Vietnam veteran friend stated it best when
he said, ``Military honors burial is not a RIGHT, but rather a
PRIVELEGE earned by your subsequent conduct as well as your previous
service. Service to my country was a privilege and as a combat veteran,
all I expect is 6 feet of hallowed ground from the country that I love.
Men like Michael Anderson DISHONOR that privilege!''
In helping to pass similar legislation in December 2006 which
resulted in the required removal of the remains of just such a person
from Arlington National Cemetery, Senator Barbara Mikulski stated that
``she was proud to not only have helped them (the Davis Family) but to
have created a law to ensure that nothing like this ever happens
again.'' Please Google the Arlington National Cemetery Web site for
``Russell Wayne Wagner'' for more complete details. It would appear
today that much of her effort has been for naught. It would seem likely
that, if not given the explicit responsibility and ``authority'' to
correct such errors, the VA will continue, without regard for justice
OR previous legislation, to continue to provide taxpayer funded
military honors burials to known killers and perpetrators of like
Capital crimes.
Please prevent the insult to injury inflicted upon families of
victims killed by veterans due to improper military burials. We
respectfully request that you support passage of S-1471, The Alicia
Dawn Respect for National Cemeteries Act, to provide the Office of
Veterans Affairs not only the responsibility, but also the clear
authority to correct, if not eliminate, this kind of error in the
future. This would avoid this type of dishonor not only toward the
families of victims, but toward all of our rightfully honored veterans.
Through this positive step, at least in some small measure,
Alicia's death will not have been in vain, but instead, an instrument
for justice and peace for our family as well as the families of future
victims of veterans turned Capital criminals.
To quote Dr. Martin Luther King, ``It is always the right time to
do the right thing!'' Now is one of those times.
Thank you!
Sincerely,
Paul J. Koehl and family
______
Prepared Statement of Brad Slagle, President,
National Association of State Veterans Homes
in support of s. 1540
Chairman Sanders, Ranking Member Burr and Members of the Committee:
Thank you for the opportunity to submit testimony on behalf the
National Association of State Veterans Homes (NASVH) in support of
S. 1540, legislation introduced by Senator Sherrod Brown of Ohio to
remove legal and financial barriers that effectively prevent State
Veterans Homes from operating homeless veterans programs.
NASVH is an all-volunteer, non-profit organization whose primary
mission is to ensure that each and every eligible U.S. veteran receives
the benefits, services, long term health care and respect which they
have earned by their service and sacrifice. NASVH also ensures that no
veteran is in need or distress and that the level of care and services
provided by State Veterans Homes meets or exceeds the highest standards
available. The membership of NASVH consists of the administrators and
senior staffs at 146 State Veterans Homes in all 50 States and the
Commonwealth of Puerto Rico.
Mr. Chairman, the State Veterans Homes system is a mutually
beneficial partnership between the States and the Federal Government
that dates back more than 100 years. Today, State Homes provide over
30,000 nursing home and domiciliary beds for veterans and their
spouses, and for the gold-star parents of veterans. Our nursing homes
assist the VA by providing long-term care services for approximately 53
percent of the VA's long-term care workload at the very reasonable cost
of only about 12 percent of the VA's long-term care budget. VA's basic
per diem payment for skilled nursing care in State Homes is
approximately $100, which covers about 30 percent of the cost of care,
with States responsible for the balance, utilizing State funding and
other sources. On average, the daily cost of care of a veteran at a
State Home is less than 50 percent of the cost of care at a VA long-
term care facility. The VA per diem for adult day health care is
approximately $75 and the domiciliary care rate is approximately $42
per day.
The bill before the Committee, S. 1540, has been drafted by Sen.
Brown in consultation with NASVH to address a problem in Title 38 that
effectively prevents State Homes from operating homeless veterans
programs, even when a Home has excess capacity that could be used to
help fight the pernicious problem of homelessness amongst veterans.
According to the Department of Housing and Urban Development, on any
given night there are over 60,000 homeless veterans, and more than
twice that many experience homelessness at some point each year. This
shameful fact led VA Secretary Shinseki to make ending homelessness
amongst veterans by 2015 one of his highest priorities and enactment of
S. 1540 could add State Veterans Homes to his arsenal of tools in that
effort.
Mr. Chairman, some State Homes currently have unused bed capacity
in their domiciliary programs that could be used to operate homeless
veterans programs. For example, the Ohio Veterans Home in Sandusky,
Ohio has both a 427 bed nursing home program and a separate 300 bed
domiciliary program. While the nursing home program has a 98 percent or
higher occupancy rate, the domiciliary is currently operating at less
than 60 percent occupancy, leaving more than 125 beds available at any
given time. The administrators at Sandusky have been exploring ways to
use a small number of their unused domiciliary beds to help homeless
veterans.
However, eligibility requirements for admission to the Ohio
Veterans Home domiciliary program limit or restrict admission for most
homeless veterans. To be admitted to the domiciliary, a veteran must
provide a current medical history and physical completed by a
physician, along with detailed financial documentation demonstrating
need for this assistance, as well as other information. Often homeless
veterans lack the resources to obtain such information required for
possible admission so the Ohio Veterans Home has been looking for other
ways to use their facility to support homeless veterans.
Learning about VA's Health Care for Homeless Veterans (HCHV)
program, which provides grants to community homeless programs, the
Sandusky Home drew up plans for a small homeless program using HCHV
funding as a source of support. Under this proposed program, they would
be able to admit homeless veterans without the tighter domiciliary
requirements, allowing them immediate access to food, shelter, primary
care, social services and other services. There are also a number of
recently deployed veterans that may need a stable transition facility
for post-acute care but who don't fall into the admissions criteria
outlined in the VA domiciliary care program regulations. Because
homeless veterans generally need more intense services initially to
help them to stabilize and adjust, the Home also developed plans to
work collaboratively with the VA Homeless Coordinators in an effort to
help the veteran with any specific needs they may have, which could
include education, job training and long term housing.
After approaching VA with this proposal, the Sandusky Home was told
that under Title 38 regulations, State Homes are only authorized to use
their federally-supported homes to operate three programs: skilled
nursing care, adult day health care and domiciliary care. According to
VA's Office of General Counsel, if a State Veterans Home applied for
and received a grant to operate a homeless veterans program, VA would
have to recapture a portion of the construction grant funding
previously awarded to the State Home over the past twenty years. This
recapture of Federal funds would be such a severe financial penalty
that it would effectively prevent any State Veterans Home from even
considering a homeless veterans program.
To remove this obstacle, S. 1540 would amend the recapture
provisions (38 U.S.C. Sec. 8136) by providing an exemption for State
Homes that receive a contract or grant from VA for residential care
programs, including homeless veterans programs. This provision would
not require VA to award grants or contracts to State Homes; VA would
retain the authority and discretion to determine when and where it
might make sense for a State Home to use a portion of its empty beds to
help homeless veterans. Nor would it open the door to State Homes
converting domiciliary programs into homeless veterans programs on
their own; only VA's decision to provide funding through a grant or
contract would exempt them from the recapture provisions.
S. 1540 would create opportunities for some State Homes with
underutilized bed capacity in their domiciliary programs to apply for
VA grants to that excess capacity to operate a homeless veterans
program, thus providing additional support for helping to end the
scourge of homelessness amongst America's veterans. This commonsense
legislation would not increase Federal spending, rather it would simply
allow State Veterans Homes to compete for existing VA grants just as
private community organizations presently do.
Mr. Chairman, on behalf of the National Association of State
Veterans Homes, I am pleased to offer our strong support for this
legislation and respectfully request that this Committee favorably
consider and report this legislation to the full Senate for its
approval. This concludes my testimony. I would be pleased to respond to
any questions you or Members of the Committee may have.
______
Prepared Statement of the National Board for Certified Counselors, Inc.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of the National Coalition for Homeless Veterans
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
______
Prepared Statement of Paralyzed Veterans of America
Chairman Sanders, Ranking Member Burr, and Members of the
Committee, Paralyzed Veterans of America (PVA) would like to thank you
for the opportunity to present our views on the broad array of pending
legislation impacting the Department of Veterans Affairs (VA) that is
before the Committee. These important bills will help ensure that
veterans receive timely, quality health care and benefits services.
s. 875, the ``department of veterans affairs disease reporting and
oversight act''
PVA supports S. 875, a bill to amend title 38, United States Code,
to require the reporting of cases of infectious diseases at facilities
of the Veterans Health Administration. The VA is a national leader in
the public health sector with high standards for both quality care and
patient safety. S. 875 will only augment such standards and increase
the national standard for patient safety, as well as allow for
accountability when the unfortunate incidence of infectious disease is
reported.
s. 1148, the ``veterans benefits claims faster filing act''
PVA supports S. 1148, the ``Veterans Benefits Claims Faster Filing
Act.'' This legislation will ensure that veterans have access to
greater information when submitting a claim. Providing information on
average wait times for claims processing and the percentage of claims
approved will increase the understanding of the process and may help
set expectations of how long a veteran may have to wait for a claim to
be adjudicated.
s. 1155, the ``rural veterans mental health care improvement act''
The ``Rural Veterans Mental Health Care Improvement Act,'' proposes
to provide advance appropriations for information technology accounts
of the VA, include mental health professionals (marriage and family
therapists and mental health counselors) in VA training programs,
expand mental health services for families of veterans, and require VA
to provide Congress with a report on its telemedicine services.
PVA understands the positive impact that advance appropriations of
VA medical Care accounts has had on the delivery of health care
services to veterans in the most recent budget cycles, and therefore,
supports the general intent of this particular provision. However, we
believe that the Committee should not focus only on accounts for health
related information technology, but rather, VA should be given the
authority to provide advance appropriations for all discretionary
accounts. Therefore, we ask that the Committee consider S. 932, the
``Putting Veterans Funding First Act of 2013,'' which proposes to amend
title 38 to provide advance appropriations for VA discretionary
accounts.
The second provision of this bill proposes inclusion of mental
health professionals in VA's education and training program for health
personnel. As this program was created to enhance VHA services and
ensure that an adequate supply of health personnel is available in the
medical field, PVA believes that specific positions such as marriage
and family therapists, and licensed professional mental health
counselors should be added based on the need identified by the VA.
Last, PVA fully supports the provisions of this bill that would
expand mental health services for families of veterans at VA Centers
for Readjustment Counseling, and require VA to report on specific
aspects of its telemedicine services.
s. 1165, the ``access to appropriate immunizations for veterans act''
PVA supports S. 1165, which proposes to amend title 38, United
States Code to provide for requirements related to the immunization of
veterans. It is accepted fact that proper and timely administration of
immunizations can prevent the onset of more significant medical issues.
By ensuring that immunizations are administered in compliance with the
recommended adult immunization schedule, it can be expected that
veterans using the VA will be healthier and less likely to suffer
potential medical ailments. Proper and timely immunizations are a
guarantee of better medical health in the VA patient population.
s. 1211
PVA supports S. 1211. As veterans make plans for their future and
make decisions on continuing their education or seek further technical
training they need facts pertaining to institutions and training
programs. The information needed would be facts such as how many
veterans attend a school or program, how many veterans complete the
program, what supports are available for veterans enrolled in a
program, and how many veterans find employment in that field after
completing or graduating from a program. This information is often not
available as veterans make decisions for their future. Unfortunately
the number of new schools and training programs aimed at veterans has
burgeoned specifically as a result of the Post-9/11 GI Bill.
Organizations that resort to using ``Post-9/11 GI Bill'' or ``GI Bill''
in their promotion most likely are among organizations that intend to
mislead veterans. PVA supports this legislation that would prohibit the
use of any reference to this earned veterans' benefit in advertising or
promotions.
s. 1216, the ``improving job opportunities for veterans act''
PVA supports S. 1216, the ``Improving Job Opportunities for
Veterans Act of 2013,'' which assures certain requirements for career
training programs for veterans. This legislation would require, for a
four-year period, that training establishments that apply for state
approval of on-the-job training programs must certify that the wages to
be paid to the eligible veteran or person upon entrance into training
will be increased in regular periodic increments. By the last full
month of the training period, wages paid to the veteran will be at
least 75 percent (currently 85 percent) of the wages paid for the job
for which the eligible veteran or person is being trained. This reduces
the financial responsibility for employers by 10 percent. Hopefully
this reduction for the employer, with the financial difference being
paid by the VA, will be an incentive for employers to participate.
The legislation also extends from November 30 through December 31,
2016, the requirement of a reduced pension ($90 per month) for veterans
(with neither spouse nor child) or surviving spouses (with no child)
covered by Medicaid plans under title XIX of the Social Security Act
for services furnished by nursing facilities.
This legislation also directs the VA to enter into agreements with
other Federal agencies to operate similar on-the-job training programs
for eligible veterans to perform skills necessary for employment by the
department or agency operating the program. This initiative would be an
excellent program to ensure that the men and women that served their
country will be trained and prepared to continue serving their country.
While this bill has great potential to improve job opportunities
for veterans, we do have concerns about accountability of the program.
Specifically, how will the provisions outlined in the bill be enforced?
How will the Federal agencies involved in this program be evaluated?
Moreover, what will be the penalty for agencies that do not embrace
this program? This program could help thousands of veterans establish
careers in the Federal Government if it is presented as a requirement,
firmly backed by the Administration, and closely monitored.
s. 1262, the ``veterans conservation corps act''
PVA supports S. 1262, the ``Veterans Conservation Corps Act of
2013.'' This legislation requires the VA to coordinate and develop
agreements with other Federal programs including the Department of
Justice, Department of Agriculture, Department of Commerce, Department
of Interior, Homeland Security, and the Chief of Engineers, to
establish a Veterans Conservation Corps. This program will provide
training and employment opportunities to help veterans in the
transition from military service to civilian life. Veterans who
participate in this Conservation Corp program will perform work in
Conservation, Resource Management, and Historic Preservation Projects
on public lands and maintenance and improvement projects for cemeteries
under the jurisdiction of the National Cemetery Administration.
Similar agreements with other agencies will be established allowing
veterans to learn from and perform in positions such as firefighters,
law enforcement officers, and disaster relief personnel. These Federal
agencies will employ veterans to perform these functions within their
agencies, or award grants to, or contracts with, state governments,
local governments, or nongovernmental entities to employ veterans to
perform work in these areas.
PVA does not support the section that specifies that a priority for
the employment of veterans shall be given to those veterans who served
on active duty in the Armed Forces on or after September 11, 2001. We
believe any unemployed veteran that honorably served who needs and
deserves a job should be afforded an equal opportunity.
PVA supports most of this effort to provide veterans with the
opportunity to continue to serve in various capacities throughout their
communities. However, this program will require extensive oversight by
the VA and Congress. Requiring Federal agencies to develop, adapt, and
embrace additional responsibility is always met with resistance.
s. 1281, the ``veterans and servicemembers employment rights
and housing act''
PVA supports S. 1281, the ``Veterans and Servicemembers Employment
Rights and Housing Act of 2013.'' This legislation prohibits employment
practices that discriminate based on an individual's military service
and amends the ``Fair Housing Act'' and the ``Civil Rights Act of
1968'' to prohibit housing discrimination against members of the
uniformed services. The legislation will protect veterans against
employers who fail to hire, discharge, or otherwise discriminate
against veterans because of their military service. It also prohibits
employers, employment agencies, labor organizations, and job training
programs from engaging in specified practices that adversely affect an
applicant or employee because of military service. Ultimately, PVA
supports the concept of adding military veterans as a category or group
into certain Federal laws that currently prohibit discrimination based
on a particular category or group of individuals.
s. 1295
PVA strongly supports S. 1295 to require the Secretary of Veterans
Affairs to provide veterans with notice, when veterans electronically
file claims for benefits that relevant services may be available from
veterans service organizations. One of PVA's main goals and mission
objectives is to help veterans receive the benefits they so richly
deserve. PVA, like other Veterans Service Organizations, has
established a network of Service Officers across the country for this
specific purpose. The VA claims process can be challenging and
laborious for those who do not understand it. This is particularly true
for those with catastrophic injuries or complex claims. While VA does a
good job of providing information about the availability of VSO support
to veterans wanting to file a claim, requiring this in any electronic
filing program VA may create will be a guarantee that this information
is provided to veterans and not overlooked by a software programmer.
s. 1296, the ``servicemembers' electronic health records act''
PVA generally supports S. 1296, a bill to create a specific
timeline for the VA and the Department of Defense (DOD) to achieve
interoperable electronic health records. PVA believes that VA and DOD
must remain committed to completing an electronic health record that is
fully interoperable, and allows for a two-way electronic exchange of
information that is accessible and can be computed by medical
professionals. This bill will require both VA and DOD to engage in
continuous dialog to determine the best means for information exchange,
as well as discuss the feasibility of creating a data storage system to
improve accessibility of patient health records and data. While this
bill does not address the issues that have prevented the implementation
of a fully interoperable electronic health records system, it does
attempt to move the process forward with specific dates to assess and
evaluate the current status of the initiative. As stated in the FY 2014
Independent Budget, ``[PVA] remains firm that VA and DOD must complete
an electronic medical record process that will help patients transition
between health care settings; reduce duplicative testing, and improve
patient safety.''
s. 1361, the ``world war ii merchant mariner service act''
While PVA recognizes the valuable service provided by the Merchant
Marines during World War II, PVA has no position on S. 1361, the
``World War II Merchant Mariner Service Act.''
s. 1399
PVA supports S. 1399, the ``Servicemembers Student Loan
Affordability Act.'' This legislation would amend the Servicemembers
Civil Relief Act (SCRA) to extend the interest rate limitation on debt
entered into before military service and debt incurred during military
service as well as to consolidate or refinance student loans incurred
before military service. Loan consolidation is a practical, effective
way to manage student loan debt. The consolidation of one or more
student loans incurred by the servicemembers before military service
shall be limited to an interest rate of 6 percent.
s. 1411, the ``rural veterans health care improvement act''
PVA supports S. 1411, to specify requirements for the next update
of the current strategic plan for VA's Office of Rural Health (ORH).
PVA believes that attracting and retaining adequate staff within the
Veterans Health Administration (VHA) is one of the most critical
elements of providing quality health care in a timely manner.
Recruiting and retaining medical professionals in rural settings
continues to be a challenge as the population of veterans residing in
rural areas continues to grow. PVA believes that the requirements of
S. 1411, to include specific goals and objectives in the current ORH
strategic plan has the potential to further develop and expand upon the
improvements that VA has already made in the area of rural health care.
Particularly, PVA is pleased that this bill requires VA leadership to
define specific goals and objectives in the areas of recruitment and
retention, and enhance the use of current programs using technology to
increase veterans' access to VA health care services.
This bill also requires the VA ORH to ``refresh'' the strategic
plan so that it includes goals and objectives for ensuring timeliness
and improving the quality of health care services provided through
contract and fee-basis providers. PVA believes that non-VA providers
serve a purpose in meeting the health care needs of veterans residing
in rural areas and are an essential component of the VA providing
timely care in remote settings. However, such options should not be
used as a method or course to eliminate VA facilities. PVA believes
that the greatest need is still for qualified VA health care providers
to be located in rural areas. We believe that the VA is the best health
care provider for veterans. Providing primary care and specialized
health services is an integral component of VA's core mission and
responsibility to veterans.
s. 1434
PVA's National office has no position on naming the Junction City,
Kansas, community-based outpatient clinic after Lieutenant General
Richard J. Seitz. PVA believes naming issues should be considered by
the local community with input from veterans organizations within that
community. With that in mind, we would defer to the views of PVA's Mid-
America Chapter.
s. 1471, the ``alicia dawn koehl respect for national cemeteries act''
PVA has no specific position on this proposed legislation. However,
we do have some concerns as it relates to the provisions and
application of this legislation, were it to be enacted. This is an
issue that goes to the heart of the rules and rationale for the
granting and, in some most unfortunate circumstances, taking away of
benefits and entitlements conferred on this Nation's defenders by a
grateful Nation. While we are certainly sympathetic to the families
impacted by situations such as those of the namesake of this
legislation, we believe this proposal oversteps the boundary for
determination of interment in a national cemetery.
Specifically, we believe this legislation plays to the emotional
nature of capital crimes at the expense of due process. The legislation
would authorize possible disinterment of remains of veterans without
them having actually being convicted of a crime. The language negates
the concept of ``innocent until proven guilty'' by suggesting that a
veteran ``may have been convicted'' of a Federal or state capital
crime. What is the burden of proof for ``may have been convicted?''
Congress passed Public Law 105-116 in 1997 prohibiting people convicted
of Federal or state capital crimes and sentenced to death or life
imprisonment without parole from being interred at Arlington and other
national cemeteries. However, this legislation never reaches that
standard for determination for burial eligibility. It simply presumes
guilt to meet the threshold for denial of burial.
Generally, veterans tend to expect more from veterans, to hold
ourselves to a higher standard of behavior. Yet we must also realize
that, just as in other segments of society, individuals will violate
the rule of law and do unjustified harm to others. Under these
circumstances justice must be met out, and all appropriate punishment
under law applied. When Public Law 105-116 was considered, it was the
collective conclusion of most veterans' service organizations that
permitting individuals so undeserving of such honor to be buried in
veteran's cemeteries would diminish the dignity and service of other
veterans and their survivors who are fully deserving of the honor.
However, the post-military actions of individuals are not generally the
basis for consideration of eligibility for interment in a national
cemetery. And when those actions have not been adjudicated as criminal
in a court of law, we do not believe that the standard has been met to
prevent interment or disinter veterans who had been previously
honorably discharged from military service and otherwise met the
eligibility criteria.
s. 1540
PVA does not have an official position on S. 1540, a bill to amend
title 38, United States Code to include contracts and grants for
residential care for veterans as part of an exception to the
requirement that the Federal Government recover a portion of the value
of certain projects.
s. 1547, the ``veterans dialysis pilot program review act''
PVA supports S. 1547, the ``Veterans Dialysis Pilot Program Review
Act of 2013.'' If enacted, S. 1547, the ``Veterans Dialysis Pilot
Program Review Act of 2013,'' would require VA to review its current
dialysis pilot program and submit a report to Congress before expanding
the program. In 2012, the Government Accountability Office (GAO)
published a report titled, ``VA Dialysis Pilot: Increased Attention to
Planning, Implementation, and Performance Measurement Needed to Help
Achieve Goals.'' In the report many weaknesses with the pilot were
cited, as well as recommendations to improve the pilot.
S. 1547 would require VA to respond to these recommendations, as
well as prevent expansion of the program until the pilot has been
implemented for two years at each initial site. Gathering and analyzing
data to make the most informed decisions is always best when such
choices involve veterans' health care. As GAO has identified issues and
made recommendations regarding the Veterans Dialysis Pilot Program, the
VA should be required to provide Congress with current program updates
to such recommendations, as well as findings from any additional
analysis of the program. Many of the requirements established in this
bill are similar to the recommendations from the GAO report, with which
the VA concurred.
s. 1556
S. 1556, is a bill to amend title 38, United States Code, to modify
authorities relating to the collective bargaining of employees in the
Veterans Health Administration (VHA). PVA has serious concerns
regarding this bill and its potential to negatively impact VA patient
care.
Title 38, section 7422, ``Collective Bargaining'' states:
``* * * (b) [Collective bargaining] may not cover, or have
any applicability to, any matter or question concerning or
arising out of (1) professional conduct or competence, (2) peer
review, or (3) the establishment, determination, or adjustment
of employee compensation under this title.
(c) For purposes of this section, the term ``professional
conduct or competence'' means any of the following:
(1) Direct patient care.
(2) Clinical competence
(d) An issue of whether a matter or question concerns or
arises out of (1) professional conduct or competence, (2) peer
review, or (3) the establishment, determination, or adjustment
of employee compensation under this title shall be decided by
the Secretary and is not itself subject to collective
bargaining and may not be reviewed by any other agency.'' \1\
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\1\ Title 38, United States Code, Section 7422.
S. 1556 proposes to eliminate subsections (b), (c), and (d). While
PVA supports improving the collective bargaining rights and procedures
for review of adverse actions for VHA health care professionals, it is
our position that such bargaining rights should not interfere with
direct patient care and delivery of VA health care services. PVA fully
understands the invaluable commitment and service that VA medical
professionals provide to the Nation's veterans. They are the backbone
of the VHA system and should be afforded certain rights that ensure a
safe and productive work environment. As such, we strongly urge VA
leadership and union representatives to work together to identify
legislative and policy outcomes that will improve the collective
bargaining rights and procedures of VHA without impacting the direct
delivery of patient care, or amending title 38 as proposed by this
bill.
s. 1558, the ``veterans outreach enhancement act''
A common theme of many individuals who have testified before the
Senate and House Committees on Veterans' Affairs in the past has been
that many servicemembers returning to the civilian world often have
limited, or no knowledge of the programs, benefits, and assistance
available for them based on their active military service. This
legislation, S. 1558, the ``Veterans Outreach Enhancement Act'' will
help communicate the wide array of information to all veterans,
including veterans in rural areas. This legislation authorizes the
Secretary to develop and carry out a program of outreach which may
include collaborating with state and local governments to help perform
this outreach.
However, PVA has a concern that the VA may designate portions of
this outreach responsibility to the states through each states' Local
Veterans' Employment Representatives (LVER) and Disabled Veterans'
Outreach Program (DVOP) specialists. Although some states may excel at
helping veterans through these federally funded programs, traditionally
these programs do not fulfill the responsibilities of placing veterans
in employment, or informing veterans of benefits. Therefore, PVA
believes allocating more funds to individual states through these
programs will not increase the VA's outreach efforts. Most states have
a Department of Veterans Affairs. Like the state employment programs,
these vary widely in their responsibilities and performance. For the VA
to designate and rely on these offices to fulfill the VA's outreach
responsibilities will require extensive oversight of these offices.
s. 1559, the ``benefits fairness for filipino veterans act''
PVA has no official position on S. 1559, the ``Benefits Fairness
for Filipino Veterans Act of 2013.'' That being said, we do not see a
need for legislation that would essentially alter the definition of
residency for veterans in the United States.
s. 1573, the ``military family relief act''
PVA supports S. 1573 to provide payment of temporary compensation
to a surviving spouse of a veteran upon the veteran's death. The
difficult transition period for the family following the death of a
loved one is often confused and challenging. The ability of a spouse to
care for herself and her affairs can be made very difficult when their
veteran's partner passes away. This is particularly true if the spouse
had served as the primary caregiver, as is often the case for veterans
with service-connected disabilities continuously rated as total. Even
if a new widow had filed a claim for DIC or pension, the time to
process this can be lengthy. There are also reports that this
compensation is sometimes incorrectly denied at the VA Regional Office
and needs to go to an appeal before being approved. Providing temporary
compensation for a period not to exceed six months allows for an
appropriate period of transition and it is also our understanding that
VA supports this legislation.
draft bill on service-disabled insurance program
PVA generally supports this legislation that would make the needed
adjustment to update premium rates based on the most recent mortality
table for Service-Disabled Veterans Insurance. The service-disabled
veterans' life insurance began in 1951 using mortality information from
1941, information that is clearly outdated when compared to mortality
rates of the current population. Using inaccurate mortality rates
results in premiums that are more costly for veterans. Updated
mortality tables and rates should ultimately lead to a reduction in
premium rates for veterans.
draft bill on replacement automobiles for certain disabled veterans
PVA supports the proposed legislation that would improve the
adaptive automobile assistance grant. This issue has been a high
priority for PVA since our founding in 1946. For many PVA members, the
automobile (or converted van) is the only viable transportation for
their daily activities whether for employment, medical appointments,
family needs, or other activities of everyday living. As explained in
The Independent Budget (IB) for FY 2014, the cost to replace a modified
vehicle in the current market is $40,000 to $65,000. The IB also quotes
the Department of Transportation's report documenting the life span for
a vehicle of 12 years, or 128,500 miles. This legislation would
significantly increase the value of the grant to $30,000 and further
relieve the financial burden associated with the purchase of an adapted
vehicle.
This legislation also allows a veteran to use the grant up to three
times until reaching the maximum dollar amount. PVA strongly recommends
that this provision not include a delimiting date so as to be
applicable to all veterans who have qualified for the grant. As an
aside, PVA would recommend that the Committee evaluate the
effectiveness of allowing veterans to use their Specially Adapted
Housing (SAH) grant up to three times (a provision that was enacted
into law several years ago) as a basis for comparison in understanding
the potential for allowing a similar benefit with the automobile
assistance grant.
the ``veterans health care eligibility expansion and enhancement act''
The ``Veterans Health Care Eligibility Expansion and Enhancement
Act of 2013,'' proposes to amend title 38, United States Code, to
expand and enhance eligibility for VA health care services. PVA does
not support Section 2 of this bill, titled, ``Enhancement of Nature of
Eligibility for Care of Veterans.'' Specifically, this section proposes
to amend title 38, United States Code, by mandating that the VA
``shall'' furnish nursing home care to non-compensable and non-service-
connected veterans with a disability rating of 50 percent or more. With
this change the VA would not have the same mandate to provide such care
to compensable service-connected disabled veterans rated less than 50
percent. The proposed change in this section is inequitable and in
direct opposition to the purpose of the VA's disability rating system.
PVA supports Sections 3 and 4 of this bill which includes opening
enrollment to uninsured veterans not currently eligible to receive VA
health care services and extending the period of eligibility for health
care for veterans of combat service. PVA appreciates that this bill
attempts to increase veterans' access to VA health care services,
especially long-term care services. Particularly, we support Section 3,
to open enrollment for veterans that are legally eligible for VA health
care, but not eligible to enroll at this time. PVA believes that this
is most appropriate given the national coverage mandate from the
``Patient Protection and Affordable care Act.'' We encourage the
Committee to enact all of the aforementioned provisions and provide the
resources as needed to account for any increase in utilization and
demand for services.
the ``enhanced dental care for veterans act''
PVA generally supports the provisions of the ``Enhanced Dental Care
for Veterans Act.'' That being said, we have some concern about the
potentially high cost that his proposal could have on the VA. Dental
services are generally not cheap. Such a potential broad-based
expansion could significantly increase the overall cost to provide
health care for the VA. With this in mind, it will be incumbent upon
Congress to ensure that sufficient resources over and above what are
currently provided are made available to carry out both the pilot
program that is proposed and any additional expansion that may come as
a result of the pilot program.
the ``mental health support for veteran families and caregivers act''
PVA supports the ``Mental Health Support for Veteran Families and
Caregivers Act of 2013. This legislation proposes to establish both an
education program and peer support program for family members and
caregivers of veterans with mental health disorders. PVA fully
understands the importance of providing educational and support
services to those who care for veterans with both physical disabilities
and mental health disorders, as the majority of our members rely on the
assistance of a family member or caregiver. The education and peer
support programs will allow veterans' family members and caregivers to
become fully incorporated in their treatment plan. We ask that the
Committee consider providing variations on the 10 week education
program to accommodate the busy schedules of the family members and
caregivers of veterans. Regardless of where and how the program is
facilitated, 10 weeks may discourage individuals from enrolling in, or
completing the program. Providing an option that can be completed in
less time as an alternative option to the 10 week program may be more
appealing to family members and caregivers who are balancing
responsibilities of family, career, and caring for a veteran.
the ``medical foster home act''
PVA supports the ``Medical Foster Home Act of 2013, which proposes
to authorize the VA to cover the costs associated with the care of
veterans at medical foster homes. Too often the costs of care while at
a medical foster home leave veterans financially insolvent. Codifying
this authority will allow the VA to increase access to long-term care
services for veterans who would otherwise be forced into more
traditional means of institutional care.
the ``survivors of military sexual assault and domestic abuse act''
PVA supports the ``Survivors of Military Sexual Trauma Assault and
Domestic Abuse Act of 2013. If enacted, this bill would authorize VA to
provide counseling and treatment for sexual trauma to members of the
Armed Forces, screen for domestic abuse, and submit reports to Congress
on military sexual trauma and domestic abuse. VA has made great strides
in the development and progression of quality mental health and caring
for those who have survived military sexual trauma assault; therefore,
it is a logical next step to make such care available to servicemembers
who will likely enroll in VA health care in the near future. PVA is
pleased to see that this legislation also proposes to remove the
language that is gender specific and uses servicemembers' time of
service as factors when dealing with the treatment of both military
sexual trauma assault and domestic violence. Care should be provided to
veterans based solely on need.
draft bill on reimbursement for emergency medical treatment
PVA generally supports the intent of the proposed draft bill that
would eliminate the requirement that veterans be seen within the prior
24-month period when seeking reimbursement for medical treatment.
However, we have real concerns about the inequity created by the
legislation. While we understand the concern about veterans being seen
in a timely manner when having an initial appointment with primary care
providers, we do not believe that this population should receive
special treatment for emergency care reimbursement simply because of
the nature of when they are seeking treatment. Moreover, qualifying the
concept that VA has specifically imposed a waiting period for
appointments is primarily based on anecdotal evidence, not quantifiable
evidence.
Additionally, this legislation seemingly discriminates against new
enrollees who may choose not to have an immediate VA appointment
because he or she is generally healthy. Likewise, it treats all other
veterans who are otherwise enrolled in the VA differently when it comes
to emergency care reimbursement. In order to be fair and equitable,
this legislation should eliminate the 24-month requirement entirely.
the ``improved compensation for hearing loss act''
PVA supports the proposed legislation, but cautions that reports
are only a first step and are not enough. In particular, PVA thinks it
is important to examine the actions by VA to implement the findings and
recommendations of the 2006 Institute of Medicine report on ``Noise and
Military Service: Implications for Hearing Loss and Tinnitus.''
Additionally, the examination of those members of the Armed Forces not
included on the Duty Military Occupational Specialty Noise Exposure
Listing who were precluded from receiving benefits related to hearing
loss. Many aspects of the Nation's current conflicts have had to be
reevaluated as the combat environment has changed. An examination is
not only prudent, but critical to caring for and compensating our
veterans. This together with an explanation of the rationale for the
practice of VA not issuing a compensable rating for hearing loss at
certain levels that are severe enough to require the use of hearing
aids is needed to understand how VA is making its determinations.
Finally, while it is important to examine the problems with VA
practices on providing services to veterans with hearing loss, PVA
expects to see further legislation to correct any deficiencies or
improper practices that are identified.
draft bill on national center for toxic research and services
for veterans' descendants
While PVA understands the underlying intent of the proposed bill,
we do not support the, ``Toxic Exposure Research and Military Family
Support Act of 2013.'' This legislation proposes to select a VA medical
center to serve as the national center for the diagnosis, treatment,
and research of health conditions of descendants of individuals exposed
to toxic substances while serving as members of the Armed Forces. We
appreciate that this bill recognizes the importance of providing the
descendants of veterans who have been exposed to toxic substances with
quality, effective care. However, we believe that this responsibility
does not rest with the VA. We believe that this requirement would be
most successfully carried out if coordinated through a public health
agency with a broader mission and health care focus, such as the
Department of Health and Human Services, or the National Institutes of
Health, with the direct support of the Department of Defense.
We believe that the provisions of this bill are outside of the VA's
official mission, and entitle the descendants of veterans to services
and benefits that are unavailable to even service-connected veterans
enrolled in the VA health care system. We fully object to the provision
of this legislation that would entitle the descendants covered by this
proposal to comprehensive caregiver assistance, a benefit that is
currently denied to every catastrophically disabled veteran injured
prior to September 11, 2001.
Additionally, we have concerns about the proposed Advisory
Committee. First, the provisions of the bill exclude organizations such
as PVA, Disabled American Veterans, and other 501(c)(3) veterans
service organizations from being represented on the Committee. We also
question on what grounds this Advisory Committee should have subpoena
authority? While we understand that such ability might improve its
efforts, it has no real legal standing or grounds to punish individuals
who might choose to ignore a subpoena.
PVA would once again like to thank the Committee for the
opportunity to submit our views on the legislation considered today. We
would be happy to answer any questions that you may have for the
record.
______
Prepared Statement of National Legislative Service, Veterans of Foreign
Wars of the United States
Mr. Chairman and Members of the Committee: On behalf of the men and
women of the Veterans of Foreign Wars of the United States (VFW) and
our Auxiliaries, thank you for the opportunity to provide our testimony
for the record regarding pending health and benefits legislation.
s. 875, department of veterans affairs disease reporting and
oversight act of 2013
The VFW supports most provisions of this legislation which would
require VISN directors to report within 24 hours the presence at a VA
facility of any infectious disease that is on the list of nationally
notifiable diseases published by the Council of State and Territorial
Epidemiologists and the Centers of Disease Control and Prevention
(CDC), or covered by a state law that requires the reporting of
infectious diseases, to VA Central Office, the Director of CDC, and the
state and county in which the facility is located. For each individual
who has contracted or is at risk of contracting a notifiable infectious
disease at a VA facility, the VISN director would be required to notify
the individual and the individual's next of kin, the individual's
primary health care provider, the county in which the individual
resides, and each employee of the VA facility. The VISN director would
then be required to confirm the receipt of each notification within 24
hours and develop and implement a plan of action to prevent the spread
of the infectious disease within seven days and maintain a record of
infectious disease reports for at least 10 years.
Timely disease reporting is critical in detecting, controlling, and
preventing the spread of communicable disease, and is a widely accepted
norm of sound public health practice. Since the laws which create
disease reporting requirements are established by individual state
legislatures, they do not apply to Federal entities, including VA.
Although individual facilities may have disease reporting policies,
they lack statutory guidance across the department can lead to
dangerous outcomes, as seen by the recent outbreak of Legionnaires '
disease within the VA Pittsburgh Healthcare System (VAPHS) which
resulted in the preventable deaths of at least five veterans and the
infection of as many as 16 others. Subsequent reports by OIG and CDC
found that the failure by VAPHS to properly address the outbreak in a
timely manner contributed greatly to the spread of the disease. Had
more stringent disease reporting protocols been in place, this terrible
tragedy may have been averted. The VFW strongly supports the provisions
of this legislation which would strengthen VA standards in reacting to
infectious disease outbreaks and mandate that VISNs report instances
notifiable infectious disease to Federal, state, and local authorities.
The only provision of this legislation that the VFW does not
support is the requirement that the Secretary suspend any VISN director
who is found by OIG to have failed to comply with disease reporting
requirements. While we recognize the necessity for accountability, we
feel that VA must be allowed to retain ultimate authority over how
punishments are applied in each unique situation. To allow the results
of OIG reports to determine which employees are to be punished would
essentially grant enforcement power to OIG, undermining the authority
of the Secretary. For this reason, we suggest that paragraph (2) of
subsection (f) Enforcement and Disciplinary Action should be changed by
striking ``suspend'' and adding ``take disciplinary action up to and
including the suspension of.'' Such a change would allow the VFW to
offer its full support to this legislation.
s. 1148, veterans benefits claims faster filing act
This legislation would require VA to provide public notification
and notice to applicants submitting for a claim for benefits of the
average times for processing claims. The intent of this bill would be
to show the benefits of filling fully developed, electronic claims.
The issue that arises from this that each claim that is filed under
the methods described in Section 2, paragraph (c)(2) is unique to
itself and factors outside of the method used to file will have an
impact on the length of time it will take to properly adjudicate the
claim. Stating the average time to adjudicate a claim under a certain
method will set an expectation for the veteran that may not be
realistic, and it may put pressure on claims processors to adjudicate
claims quickly, regardless of quality. Instead of stating the average
time it takes to complete a claim using a particular method, it might
be more accurate and realistic to state a claim that is filed using a
particular method is completed, on average, so many days faster. This
will help manage veterans expectation and remove arbitrary dates that
will put undue pressure on claims processors that will lead to
inaccurate decisions and increased appeals by veterans.
Also, amendments are needed to improve the accuracy of Section 2,
paragraph (b)(2) and Section 2, paragraph (c)(B). Paragraph (b)(2)
would need to be amended to clarify the language that only original
claims may qualify for the extra year of benefit payment. Paragraph
(b)(2) would need to be amended to change ``durable power of attorney''
to ``limited power of attorney.''
s. 1155, rural veterans mental health care improvement act
The VFW supports this legislation which contains several provisions
that improve the quality of mental health services for rural veterans.
By providing advance appropriations for VA Information Technology (IT)
Systems account, this legislation would ensure that VA care is
delivered without any disruption to the replacement of medical
equipment or the functioning of information systems. The VFW supports
this provision, strongly believing that all VA accounts should receive
advance appropriations.
This legislation would also include licensed mental health
counselors and marriage and family therapists for participation in the
VA Health Professionals Trainee Program, which is used as qualifying
training to hire mental health care providers to work within VA. The
VFW is hopeful that the recently signed Patient-Centered Community Care
(PCCC) contracts will provide the needed specialty health care
providers in these rural and remote locations. The VFW recommends
waiting for full implementation of PCCC and evaluating remaining gaps
in care before expanding the eligibility for participation in the VA
Health Professionals Trainee Program. Any program expiation must not
reduce the quality of care that is delivered.
The VFW also supports the provision of this legislation which would
strengthen the language in current law providing mental health services
to family members of Post-9/11 veterans. Finally, this legislation
requires VA to submit a report to Congress describing any factors which
are impeding the expansion of telehealth services. The VFW believes
that telehealth has great potential to improve access to VA programs
and services for rural veterans, and any barriers to its expansion must
be identified and overcome.
s. 1165, access to appropriate immunizations for veterans act of 2013
The VFW strongly supports this legislation which contains two
important health-related enhancements for veterans. The bill would
ensure that veterans receive the full complement of immunizations on
the recommended adult immunization schedule established by the Centers
for Disease Control and Prevention (CDC) Advisory Committee on
Immunization Practices (ACIP). It would also mandate that VA develop
and implement quality measures and metrics to ensure that veterans
receiving VA medical services receive each immunization at the proper
time according to the ACIP.
As many as 70,000 American adults die each year in from vaccine-
preventable diseases. In 2008, CDC estimated that the number of deaths
among adults that could be prevented by vaccination is greater than the
number of deaths caused by breast cancer, colorectal cancer or prostate
cancer combined. The VFW believes the evidence is clear that
vaccination is one of the safest, most cost effective ways to prevent
disease and death from infectious diseases.
Efforts to quantify and track vaccine utilizations in the past have
clearly shown that prioritizing increased utilization and effectiveness
of vaccination inoculations, in tandem with rigorous performance
measures, generate monumental savings while improving patient health.
When VA adopted performance measures for influenza and pneumococcal,
significant improvement in vaccine utilization rates resulted--from 27
percent to 77 percent and 26 percent to 80 percent, respectively.
Expanding performance measures to the entire list of VA and CDC
recommended adult vaccinations would undoubtedly promote timely and
appropriate vaccinations while placing a greater emphasis on
preventable care for veterans.
s. 1211, a bill to amend title 38, united states code, to prohibit the
use of the phrases gi bill and post-9/11 gi bill to give a false
impression of approval or endorsement by the department of veterans
affairs.
In 2011, the VFW signed on to a letter to the White House calling
on VA to trademark the phrase ``GI Bill.'' Through the VFW's advocacy,
this recommendation was included in Executive Order No. 13607, which
improved consumer resources for student veterans. The VFW agrees in
principle with Sen. Boxer on this legislation, which seeks to ensure
that veterans cannot be duped by bad actors in higher education by
misrepresenting themselves as a VA-associated entity or a GI Bill-
sanctioned institution or informational tool. However, we believe that
this legislation is unnecessary since VA successfully trademarked GI
Bill in 2012.
s. 1216, improving job opportunities for veterans act of 2013
The VFW supports Sen. Bennett's legislation to modify VA's on-the-
job training (OJT) program in a manner that will encourage more
companies to participate by lowering the out-of-pocket cost to the
employer during the training program. College is not for everyone,
which is why the VFW has long supported OJT as an option for GI Bill-
eligible veterans. OJT programs offer veterans an opportunity to
acquire critical skills that prepare them to compete in the civilian
workforce when they do not wish to pursue a college degree program.
Sadly, OJT is vastly underutilized and some companies believe that they
do not have enough incentive to participate, because of potential costs
to the company. The VFW encourages the Senate to pass this legislation,
which when coupled with an awareness campaign on VA OJT could
significantly improve real world training opportunities for veterans.
s. 1262, veterans conservation corps act of 2013
The VFW has long supported the concept of the Veterans'
Conservation Corps. In 2010, the VFW supported the concept as part of a
broader veterans' employment initiative before this Committee and last
year we expressed our support for stand-alone legislation, which is why
we are proud to support Sen. Nelson once again. We believe that a
conservation corps will offer unique opportunities to veterans who do
not participate in other Federal training programs to work preserving
national parks, monuments and other infrastructure projects.
Veterans were hit disproportionately hard by the recent recession,
and the latest employment figures for the Bureau of Labor Statistics
indicate that Iraq and Afghanistan-era veterans still struggle at
finding employment when compared to their civilian peers. The
conservation corps is just one more step to help veterans get back to
work and acquire the kinds of skills that will make them competitive in
the job market. This model succeeded for past generations of veterans
and we believe it could succeed again.
s. 1281, veterans and servicemembers employment and housing
rights act of 2013
The VFW supports Sen. Blumenthal's legislation that will ensure
veterans are offered decisive legal protection against discrimination
when seeking employment or housing. At a time when so few Americans
choose to serve in the military, some veterans may face discrimination
as a result of either their perceived future military obligations or
negative stereotypes associated with military service. This bill seeks
to align veterans' status with other protected groups who have faced
discrimination in the workplace or in acquiring housing. Veterans
should not be shut out of quality careers or denied a lease because of
their current or past military service. This legislation seeks to
ensure that it never happens again.
s. 1295, a bill to amend title 38, to require the secretary of va to
provide veterans with notice, when veterans electronically file claims
for benefits under laws administered by the secretary, that relevant
services may be available from veterans service organizations.
The VFW supports the intent of this legislation, which would codify
much of what VA is currently doing to make veterans aware of the
services veterans service organizations (VSO) can provide when filing
of claims for disabilities. Currently, on VA's ``benefits description''
page of its Web site, there is a link to request assistance from or
search a list of VSOs that can provide assistance. There is similar
information found once veterans logon to eBenefits.
The only additional measure this legislation provides is direct
notification to veterans when they begin the application process. The
VFW would support an added step, in the form of a pop-up, which would
direct the applicant to the claims assistance information page VA
already has established when applying for benefits online.
s. 1399, servicemember student loan affordability act
The VFW fully supports Senator Durbin's bill which extends SCRA
protections to servicemembers seeking to refinance or consolidate pre-
service Federal or private student loans. Currently, servicemembers
that opened student loans prior to military service that choose to
participate in the Federal Public Service Loan Forgiveness program
(PSLF) lose the six percent loan rate cap afforded to them by SCRA.
This legislation corrects this loophole and extends the option of PSLF
to servicemembers without forcing them to lose their six percent loan
rate cap. Additionally this legislation protects servicemembers seeking
to refinance student loans through debt consolidation from losing their
six percent loan rate caps. As student debt is on the rise, now second
only to mortgages, programs such as (PSLF) and debt consolidation are
both practical and effective ways to manage student loan debt.
s. 1411, rural veterans health care improvement act of 2013
VA will be reporting its findings of rural health care gaps through
its Strategic Plan Refresh for Fiscal Years 2012 through 2014 VA Office
of Rural Health. This legislation would define some of the data points
VA must report and use to determine their performance and
accountability goals. These data collection points would include
recruitment and retention of health care providers, timeliness and
quality of care by VHA and through contract and fee-based care, and the
implementation, expansion of telemedicine. VA would also be required to
describe its procedures for assessing each rural Department facility.
It is apparent that a wide gap exists between rural veterans and
their urban counterparts in the ability to access their earned VA
health benefits. With 41 percent of all VA enrollees residing in rural
areas, the VFW believes that this access gap must be closed, but the
situation is not without significant challenges. While roughly 25
percent of the U.S. population lives in rural areas, only 10 percent of
physicians practice in those communities. This highlights the need for
VA to proactively recruit and retain them in rural facilities. Of
highly rural veterans, 64 percent must travel more than four hours to
receive specialty care, emphasizing the need for VA to continue to
expand telehealth services. By addressing these and other issues, the
VFW believes that this legislation represents a positive step toward
solving the unique problems faced by rural veterans.
s. 1471, alicia dawn koehl respect for national cemeteries act
This act would codify the authority of the Secretaries of Veterans
Affairs and Defense to reconsider prior decisions of interments in
national cemeteries. Title 38, U.S.C. outlines crimes that disqualify
veterans from interment in national cemeteries, but there are no
provisions for the removal of a veteran who was laid to rest in a
national cemetery prior to the discovery that he or she had committed a
disqualifying crime.
This legislation also calls for the disinterment of a specific
veteran who committed murder, and then turned the gun on himself,
ending his life. He was buried in a national veterans cemetery six days
later. The circumstances of this case made it very difficult for VA to
discover the murder that would have precluded this veteran from
interment.
The VFW supports this legislation, but believes it falls short in
preventing future non-qualifying interments from taking place. Current
protocol requires the surviving family member to fax qualifying
paperwork--DD214 and death certificate--to the National Cemetery
Administration (NCA). Upon receipt of these documents, NCA calls the
family member and asks 16 questions. These questions range from
location of death and burial needs to cemetery choice and marital
status. Nowhere in the questioning does NCA ask a question regarding
criminal activity. The requesting family member should be required to
fill out a form that asks the current 16 questions and an additional
question regarding Federal or state capital crimes. Knowing this
information will assist NCA in investigating disqualifying crimes,
prior to the veteran's interment.
s. 1540, a bill to amend title 38, united states code, to include
contracts and grants for residential care for veterans in the exception
to the requirement that the federal government recover a portion of the
value of certain projects.
The VFW supports this legislation which would allow state veterans
homes that receive residential care contracts or grants from VA to also
contract with VA under the Health Care for Homeless Veterans (HCHV)
supported housing program. Since state veterans homes receive VA
funding for other programs, the recapture clause of section 8136 of
title 38 prohibits them from receiving HCHV funds. Only those state
veterans homes that also run outpatient VA clinics are currently
exempted from the recapture clause. This means that many state veterans
homes with empty beds are unable to offer them to homeless veterans in
their communities. Similarly exempting them from the recapture clause
would solve this problem.
The Secretary's ambitious five year plan to end homelessness among
veterans includes six strategic pillars. The sixth pillar is community
partnerships, which certainly must include state veterans homes. The
VFW strongly supports the Secretary's five year plan and believes that
state veterans homes should be utilized to the fullest extent possible
to ensure its success. As long as there are homeless veterans who need
them, beds in state veterans homes should not remain empty simply due
to the unintended consequences of a Federal regulation.
s. 1558, veterans outreach enhancement act of 2013
The purpose of this legislation is to enact a five-year program
aimed to increase awareness and access of Federal, state and local
veterans programs for servicemembers and veterans. In doing so, VA
could enter into agreements with Federal and state agencies and provide
technical assistance, award grants for projects and activities that
would build awareness and usage of programs and services provided at
all levels of government and within the nonprofit sector.
The VFW supports this legislation.
s. 1573, a bill to provide payments of temporary compensation to
surviving spouses of veterans upon the death of the veteran.
This legislation would provide six months of temporary payments of
Dependency and Indemnity Compensation (DIC) or Pension for surviving
spouses of veterans if, at the time of death of the veteran, the
veteran was in receipt of or entitled to receive (or but for the
receipt of retired or retirement pay was entitled to receive)
compensation for a service-connected disability continuously rated as
total for not less than one year immediately preceding the death of the
veteran, or if the veteran was in receipt of pension under section 1513
or 1521 of title 38 as a married veteran based on the marriage of the
veteran to the individual.
The VFW supports the intent of these provisions as a stop-gap
measure for surviving spouses during their time of greatest need.
However, as the bill is written, the benefit would be paid regardless
of whether or not the surviving spouse ever submits a claim for the
benefit. The VFW recommends that at minimum of a certificate of death
must be provided to VA by the surviving spouse, to act as an informal
claim before temporary payments begin must be submitted to VA. This
will protect the integrity of the program, but allow payments to be
made while the claim is developed and approved.
a draft bill to amend title 38, united states code, to provide
replacement automobiles for certain disabled veterans and members of
the armed forces, and for other purposes.
The VFW supports this legislation which would allow VA to replace a
vehicle provided to a veteran under the Automobile Grant Program twice,
with the aggregate amount of the original and replacement vehicles not
to exceed the maximum amount allowable under the program. Further, it
increases the maximum amount from $18,900 to $30,000 and authorizes VA
to replace vehicles provided under the program that are destroyed by
natural disasters or other circumstances in which the veteran is found
to be not at fault.
Currently, the VA automobile grant is a one-time benefit. Veterans
may use the grant only once in their lifetimes, regardless of whether
they purchased a vehicle for less than the full amount allowable under
the law, or if that amount is ever increased. The VFW believes that
eligible veterans should be able to receive additional grants if the
grant amount for the initial vehicle was less than the maximum. This
legislation achieves that goal, providing greater spending flexibility
for eligible veterans and ensuring that they are able to make full use
of the benefit.
VA automobile grants are provided only to the most severely
disabled veterans who may require vehicles with specific
accommodations. The original intent of the grant when it was
established in 1946 in the amount of $1,600 was to cover 100 percent of
the cost of a new vehicle. According to the Department of
Transportation, the average costs of a modified vehicle today range
from $40,000 to $65,000 new and $21,000 to $35,000 used. Although the
current automobile grant amount of $18,900 is useful to veterans as a
means of cost abatement, it does not come close to covering the full
purchase price. Clearly the grant has not been sufficiently increased
over time, relative to inflation. Increasing the amount to $30,000
would represent a big step toward ensuring that severely disabled
veterans are able to afford the specialized vehicles they need.
draft bill, veterans health care eligibility expansion and
enhancement act of 2013
This legislation calls for extraordinary changes to the Veterans
Health Administration by providing for the largest enrolment
eligibility expansion in over a decade. The VFW supports the intent of
this legislation, however, we would like to offer certain caveats and
recommend several changes before we are able to offer our full
endorsement.
Section 3 would greatly expand VA patient enrolment by extending
eligibility to veterans with non-compensable service-connected
disabilities rated as zero percent disabling and those without service-
connected disabilities who are not currently able to enroll, so long as
they do not have access to health insurance, except through a health
exchange established by the Patient Protection and Affordable Care Act.
The VFW supports the spirit of this section, as it would provide an
increased number of honorably discharged veterans with access to
quality health care who may not otherwise have that opportunity. We are
concerned, however, that a large influx of new enrollees could
overcrowd the system, exacerbating already unacceptably long wait
times. In order to prevent this, VA would presumably need to expand its
capacity by hiring additional employees and constructing or leasing new
facilities. This would require either a significant funding increase,
or the redirection of funding from other areas of the VA budget which
the VFW could never support. With no discernible offset, we feel that
there is some cause for trepidation. As a result, we must state that
the VFW would only support the eligibility expansion called for by
section 3 if VA is provided the additional funding necessary to carry
it out, without compromising current quality or access standards, or in
any way diminishing the programs and services provided to those already
enrolled. It is important that the care provided of veterans who are
service-connected or have finical need is not disrupted or diminished
in any way. Also, with rapid expiation a plan must be put in place to
account for the capacity issues that will arise. The VFW looks forward
to working with the Committee on solving these issues.
Section 4 would further extend the period of eligibility for health
care benefits for veterans of combat during certain periods of
hostilities and war. Eligibility for Iraq and Afghanistan veterans
would be extended from five to ten years following separation from
service, and eligibility for veterans of post-Gulf War hostilities
prior to January 28, 2003 would be extended until January 28, 2018. The
VFW fully supports this section.
Section 6 would simplify the method VA uses to determine which
veterans qualify for enrolment as members of low income families.
Currently, each county has its own geographically based income
threshold. This section would mandate that the highest income threshold
among the counties of each state become the income threshold of the
entire state. This would qualify many veterans for enrolment who are
currently ineligible but whose income level is relatively close to the
geographic means test threshold. The VFW supports this eligibility
expansion, but only if VA is provided with adequate funding to ensure
that access or services are not diminished for current enrollees.
draft bill, enhanced dental care for veterans act of 2013
This legislation contains several provisions relating to non-
service-connected dental services, most of which the VFW supports.
Section 2 would authorize VA to provide restorative non-service-
connected dental services, including necessary dental appliances, to
certain veterans. Currently, VA may provide those services to any
veteran receiving hospital care or nursing home care in a VA facility
if the non-service-connected dental condition is associated with or
aggravating a disability for which the veteran is receiving hospital
care, or if VA determines that a dental emergency is present during
hospitalization. This legislation would allow VA to also furnish dental
services to restore functionality that has been lost as the result of
any services or treatment received while under hospital or nursing home
care. The VFW supports this common sense fix.
Section 3 would establish a three-year pilot program at no less
than 16 locations to provide dental services to any veteran
commensurate with the dental services furnished to 100 percent service-
connected veterans. VA would be authorized to enter into contracts as
necessary and copayments would be collected. The amount expended on
each veteran per year would be capped at $1,000 or a greater amount, as
determined by VA.
VA is already set to roll out a three year pilot program to offer
affordable dental insurance to all enrolled veterans and CHAMPVA
beneficiaries known as the VA Dental Insurance Program (VADIP). Created
by the Caregivers and Omnibus Health Services Act of 2010, VADIP will
offer a wide array of dental plans to those veterans and eligible
dependents through the Delta Dental and MetLife insurance companies at
reduced rates, with care available nationwide and monthly premiums
starting as low as $8.65. While the VFW is not fundamentally opposed to
the program model offered by section 3, we are supportive of VADIP and
believe that it should function for the duration it has been authorized
and evaluated for effectiveness and veteran satisfaction before another
program which offers duplicative services, as outlined by this section,
is piloted.
Section 4 would require VA to carry out a program of education to
promote veterans' dental health. This would be achieved by distrusting
literature at VA facilities, publishing information on the VA Web site,
and conducting small and large group presentations. The VFW supports
this section.
Section 5 would require VA to establish a mechanism by which
private sector providers would be able to share information on dental
care furnished under VADIP with VA for the inclusion of that
information in the veteran's electronic health record. This information
would only be shared at the election of the veteran and VA would be
authorized to extend VADIP an additional two years if the Secretary
determines it necessary to assess the information sharing mechanism.
The VFW supports this section, strongly believing that VA must be
responsible for ensuring proper coordination and continuity of care for
all non-VA services provided under any Department program.
draft bill, mental health support for veteran families and caregivers
act of 2013
The VFW supports this legislation which would establish an
education program and peer support program for family members and
caregivers of veterans with mental health disorders. To carry out these
programs, VA would contract with non-profit entities with experience in
mental health education. The education program would consist of
instruction on types of mental health disorders, techniques for
handling crisis situations, coping with stress, and additional
services. Those who graduate the education program may be selected to
act as a peer support coordinator, who would then lead group meetings
with other family members and caregivers to assist them with matters
related to coping with mental health disorders in veterans. These
programs would initially be offered at 30 VA facilities, and the
Secretary would be required to report on the feasibility and
advisability of continuing and expanding the program after one year.
Mental health disorders among veterans often affect family members,
placing great strain on family relationships and ultimately
exacerbating the veteran's condition. If properly trained, however,
family members can have a positive impact on the veteran's recovery.
The VFW supports promoting family engagement as an important part of
mental health treatment.
draft bill, medical foster homes act of 2013
The VFW supports the intent of this legislation which will allow VA
to cover the costs associated with the care of eligible veterans who
require a protracted period of nursing home care and desire to live in
medical foster homes. VA currently has the authority to reimburse
institutional care facilities such as nursing homes for long-term
domiciliary care, but veterans who choose to live in medical foster
homes must do so at their own expense. Granting VA the authority to
reimburse medical foster homes would provide veterans with an
additional residency choice, potentially improving the quality of life
for those who would prefer to live in a family style setting rather
than an institutional one. The VFW recommends, however, that this be
achieved by amending section 1720 of title 38, United States Code,
rather than instructing the Secretary on how to carry out section 17.73
of title 38, Code of Federal Regulations. We feel that codifying this
new benefit would reduce any chance of bureaucratic misinterpretation
and ensure that it is not arbitrarily eliminated or diminished in the
future.
Furthermore, the VFW strongly believes that all non-VA services
should be provided in conjunction with proper care coordination. VA
Handbook 1141.02, Medical Foster Home Procedures, establishes the
policies and standards of VA care coordination for veterans who choose
to live in medical foster home settings. It requires an
interdisciplinary VA Home Care Team to provide the veteran with primary
care, regularly communicate with the foster home caregiver, and monitor
the care provided by the foster home with frequent unannounced visits.
The VFW feels that these requirements will continue to be instrumental
in ensuring adequate care coordination for veterans who chose to
participate in a fully-funded medical foster care program. VA Handbook
1411.02 is scheduled for recertification in 2014, and the VFW
recommends that the care coordination policies outlined in that
document be made permanent by adding them to the language of this
legislation.
draft bill, scra enhancement and improvement act of 2013
The VFW supports Chairman Sanders and Senator Rockefeller in their
efforts to improve the Servicemembers Civil Relief Act (SCRA). SCRA
exists to offer a wide range of protections to individuals entering
active duty, as well as servicemembers activated from the Reserve
Component. SCRA ensures servicemembers are able to fully devote their
attention to duty and seeks to assuage additional stress often placed
on family members of those in service. We believe many of the
provisions found in this bill offer substantial improvements to SCRA`s
current framework as they provide much-needed expansions to the bill's
depth, reach, and enforcement. For example, the VFW fully supports
offering an additional year of SCRA protection to ensure transitioning
servicemembers can organize their affairs, and we also support policies
that will ensure servicemembers cannot be denied credit because of
their military service.
The VFW applauds Chairman Sanders and Senator Rockefeller for each
taking the issue of protecting servicemembers and their families very
seriously. We are pleased that this bill offers unique solutions to
improve the many current issues related to SCRA. However, we have
several questions about the provisions in this draft of the legislation
related to servicemembers' business properties and loans on which
servicemembers serve as the guarantor or co-signor. We look forward to
discussing these issues with committee and developing a quality bill
that protects the financial and legal interests of our servicemembers.
Moreover, the VFW believes that more understanding on SCRA is
needed, which is why we recommend a possible stand-alone hearing on
SCRA in the coming year. Make no mistake, SCRA is substantially
beneficial to servicemembers, but we constantly hear stories of how
many still fall through the cracks. The VFW asks the Committee to take
an in-depth look at the financial and legal needs of our
servicemembers, solicit feedback from all relevant stakeholders, and
develop comprehensive legislation that seeks to address many of the
persistent shortfalls we often find in SCRA. We look forward to working
with the Committee to develop a comprehensive reform package that meets
the needs of today's servicemembers by protecting their financial and
legal interests.
draft bill, survivors of military sexual assault and domestic abuse
act of 2013
The VFW does not support section 2 of this legislation which would
authorize VA to provide counseling services to active duty
servicemembers for the treatment of psychological trauma associated
military sexual assault without obtaining referrals from their military
primary care providers. While we recognize the need to support victims
of military sexual assault in every reasonable way possible, we firmly
believe that any counseling or treatment should be provided at
Department of Defense facilities in order to ensure proper coordination
of care and appropriate chain-of-command involvement. Commanders are
ultimately responsible for the health and well-being of their
subordinates and it is vitally important that they are aware of the
mental health status of the members of their units. Furthermore, they
should be informed of any criminal activity which may have taken place
under their commands so that they may take appropriate action under the
Uniform Code of Military Justice.
The VFW does support section 3 which would require VA to establish
a screening mechanism to detect whether a veteran has been the victim
of domestic abuse. In recent years, VA has been making an effort to
adapt to the needs of veterans who are the victims of abuse--
specifically women veterans. Domestic abuse is a particularly prevalent
problem among this population, and detection is necessary to ensure
they receive the proper counseling and care.
The VFW also supports section 4 which would require VA to submit
reports on the treatment and prevalence of military sexual trauma and
domestic abuse. The data collected will be used to improve services for
the victims of those physically and psychologically devastating crimes.
draft bill to amend title 38, united states code, to expand eligibility
for reimbursement for emergency medical treatment to certain veterans
that were unable to receive care from the department of veterans
affairs in the 24-month period preceding the furnishing of such
emergency treatment.
The VFW supports this legislation which would authorize VA to
reimburse veterans for emergent non-VA care who do not meet the
requirement of having been seen at a VA facility in the preceding 24
months, simply because long wait times for initial patient examinations
have prevented them from doing so. The strict 24-month requirement is
especially problematic for current era veterans, many of whom have
never had the opportunity to be seen at VA facilities due to long
appointment wait times, despite their timely, good faith efforts to
make appointments following separation. Should they experience medical
emergencies during that waiting period, VA is required to deny their
claims for reimbursement, unnecessarily leaving them with large medical
bills through no fault of their own. VA is aware of the problem and has
requested the authority to make an exception to the 24-month
requirement for veterans who find themselves in this situation. The VFW
supports this request, strongly believing that under no circumstances
should long appointment wait times prevent a veteran from seeking
emergent, possible life-saving care at a non-VA facility, or expose
that veteran to financial hardship as a result of doing so.
draft bill to amend title 38, united states code, to require recipients
of per diem payments from the secretary of veterans affairs for the
provision of services for homeless for homeless veterans to comply with
codes relevant to operations and level of care provided, and for other
purposes.
The VFW supports this legislation which would require facilities
that house homeless veterans to meet the standards of the most recently
published version of the Life Safety Code of the National Fire
Protection Association, as well as all relevant local building codes
before receiving per diem payments under the VA Homeless Providers
Grant Per Diem Program. Additionally, recipients would be inspected on
an annual basis to ensure that compliance with those codes is
maintained. Current per diem recipients would have two years from the
time of enactment to be certified in compliance with relevant codes
before payments are terminated, giving them ample time to make any
necessary improvements.
Currently, VA is required to check housing certificates before
awarding grants for housing services provided to homeless veterans.
However, thorough checks of fire and safety requirements, as well as
structural conditions of the building, are often overlooked. The VFW
believes that VA funded transitional housing must be safe, secure, and
sanitary. This legislation would ensure that those standards are met,
providing homeless veterans with the best chances of successful
community reintegration.
Mr. Chairman, this concludes my testimony. I would be happy to take
any questions you or any member of the Committee may have for the
record.
______
Prepared Statement of Wounded Warrior Project
Chairman Sanders, Ranking Member Burr, and Members of the
Committee: Thank you for inviting Wounded Warrior Project (WWP) to
provide views on pending legislation. Several of the measures under
consideration address issues of keen importance to wounded warriors and
their family members, and we are pleased to offer our perspective.
mental health
We welcome the Committee's consideration of legislation addressing
key mental health issues. Long years of war have left both deep psychic
scars among those who have deployed and a profound challenge for the VA
health care system--to provide these veterans timely, effective mental
health care care. Legislation before the Committee recognizes several
distinct and important mental health issues--veterans' difficulty in
accessing mental health care in rural areas, the toll a warrior's
distress or multiple deployments may take on the mental health of
family members, and the suffering experienced by veterans traumatized
by military sexual assault or domestic abuse.
As a population, wounded warriors continue to experience very high
rates of PTSD, depression and other combat-related mental health
conditions. A recent WWP/Westat survey of more than 26 thousand wounded
warriors found that 75% of the almost 14 thousand respondents screened
positive for PTSD. The survey indicates that the effects of their
mental and emotional problems are even more serious than the effects of
physical injuries. More than 25% reported being in poor health as a
result of severe mental injuries. Our survey also found that more than
one in three respondents said they had difficulty in getting mental
health care, put off getting such care, or did not get needed care.
About 40% said one of the difficulties they had was inconsistent
treatment or lapses in treatment (such as canceled appointments and
switches in providers).\1\
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\1\ Franklin, et al., 2013 Wounded Warrior Project Survey: Report
of Findings.
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Based on the reports provided by the warriors with whom we work
daily across the country, many VA facilities are still struggling to
provide timely, effective mental health care. Wide gaps still exist
between well-intentioned policies and on-the-ground practices. Perhaps
nowhere are the challenges greater than in rural America where
workforce-staffing issues and long travel distances compound the
problems common to other often-overloaded VA facilities.
Congress has already set important expectations in law for VA's
mental health care system. Accordingly, ongoing oversight and
insistence on VA's taking further steps to close the gap between mental
health policy and practice will be critical. But we appreciate the
importance of closing statutory gaps and setting clear legislative
markers to achieve further gains.
In that regard, we strongly support mental health provisions of the
Rural Veterans Mental Health Care Improvements Act, S. 1155. We
appreciate its focus on telemental health, a promising modality, whose
full potential must be unlocked. In particular, we welcome provisions
that would clarify a longstanding requirement in section 304 of Public
Law 111-163 that the Secretary provide time-limited mental health
services to family members of veterans who deployed to Iraq or
Afghanistan, where such services are needed to assist in the veteran's
readjustment or recovery, or the family's readjustment. Given VA's
failure to implement this requirement, it is particularly important
that any ambiguity in current law be erased. Our warriors' families
have been profoundly affected by multiple deployments and by their
warriors' struggles. Some need help themselves. With the mental health
of warriors so inextricably connected to that of their loved ones'
mental health, these needs cannot be ignored.
Given the important role of the family in supporting a warrior who
is experiencing mental health problems, we welcome the Committee's
consideration of
S. , the Mental Health Support for Veteran Families and Caregivers
Act. As an organization for which peer-mentorship and peer-support are
core elements of our programming for both warriors and family members,
we would support VA's fostering the development of peer-support
programs for family members of veterans with mental health conditions.
There are likely different models that could be mounted and evaluated.
S. would direct VA to establish a two-part family support program
to consist of an education segment and the establishment of peer-
support groups. The bill directs that VA deploy this model over a four
year period through not less than 20 medical centers, 20 clinics, and
20 Vet Centers. The measure would require that the education program be
carried out over a specified period through a contract with a non-
profit entity and that the program include education on different
mental health conditions and techniques for handling crises and for
coping with stress. VA would also be required to facilitate the
establishment of a program to provide peer support to family members on
coping with mental disorders in veterans, with one family member who
completed the education segment to serve as a peer-support coordinator
and a VA mental health provider serving as a mentor to the peer support
coordinator.
While WWP applauds efforts to assist family members who are
supporting veterans with mental health needs, we recommend that the
measure provide for greater flexibility in program design. For example,
requiring that education programs include ``general education on
different mental health disorders'' may signal to VA that it must
establish ``peer'' groups inclusive of the widest possible range of
mental health conditions. But the families of young veterans with
combat-related PSTD may not relate to the experience others have with
veterans who may have very different conditions such as schizophrenia
or other cognitive disorders and who may be much older. We recommend
that the provision be revised to clarify that composition of peer-
support groups be left to the participating family members themselves.
Similarly we recommend providing somewhat greater flexibility regarding
educational content so that the programs are ultimately geared to the
needs of the participating families. Where, for example, the compelling
need for support is among families of returning combat veterans, it
would seem advisable to tailor course content to combat-stress, PTSD,
and other combat-related conditions, rather than to general education
on a broad range of conditions. As drafted, the bill would appear to
foreclose that option.
S. , the Survivors of Military Sexual Assault and Domestic
Abuse Act of 2013, would authorize the Department of Veterans Affairs
to provide counseling and treatment for sexual trauma to members of the
military as well as direct the Department to develop and deploy a
screening tool for domestic abuse to be used when a veteran seeks VA
health care services. It is certainly important, in our view, to find
avenues to improve early access to counseling and treatment for those
with MST-related health problems, as well as to assure the quality and
effectiveness of those treatments. MST has been shown to have serious
long-term adverse health implications, including PTSD, increased
suicide risk, depression, and substance abuse.\2\ Researchers report
that MST is an even stronger predictor of PTSD than combat.\3\ With the
Department of Defense reporting that 26,000 active duty servicemembers
experienced a sexual assault in 2012,\4\ it is clear that there is a
great need for resources, support, and effective treatment for those
who are coping with health issues as a result of an in-service assault.
---------------------------------------------------------------------------
\2\ M. Murdoch, et al., ``Women and War: What Physicians Should
Know,'' 21(S3) J. of Gen Internal Medicine S5-S10 (2006).
\3\ D. Yaeger, et al.'' DSM-IV Diagnosed Posttraumatic Stress
Disorder in Women Veterans With and Without Military Sexual Trauma,''
21(S3) J. Gen Internal Medicine S65-S69 (2006)
\4\ http://www.defense.gov/transcripts/
transcript.aspx?transcriptid=5233
---------------------------------------------------------------------------
However the scope of the problem is not limited to access to care.
Testimony at a recent House Veterans' Affairs Health Subcommittee
hearing provided strong evidence that both the Department of Defense
and the VA are failing to provide adequate mental health services for
veterans who had been raped by fellow servicemen. Veterans at that
hearing detailed very troubling, yet similar experiences relating not
only to access to VA care, but to inadequate screening, providers who
were either insensitive or lacked needed expertise, and facilities ill-
equipped to care appropriately for MST survivors.\5\
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\5\ http://docs.house.gov/Committee/Calendar/
ByEvent.aspx?EventID=101095
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WWP does see value in authorizing access to VA mental health care
to active duty members who experience a military sexual assault,
especially given the strong disincentives for victims either to report
or seek needed treatment within the Department of Defense.\6\ However,
we have concerns about the VA's capacity to provide such care, given
continued serious gaps in timeliness and effectiveness of its provision
of mental health care to veterans, as reflected in the recent House
hearing and as we have highlighted in previous testimony. With those
concerns, we urge the Committee to pursue these issues through
oversight, to include conducting a searching inquiry as to whether VA
has yet achieved the level of mental health staffing needed to meet the
mental health needs of our veterans. Further, we urge that such
oversight focus on improving access to MST-related care and training
providers, as needed, to provide effective screening and appropriate,
sensitive care for those seeking treatment for MST-related conditions.
---------------------------------------------------------------------------
\6\ R. Kimerling, et al., ``The Veterans Administration and
Military Sexual Trauma,'' 97(12) Am. J. of Public Health 2163 (2007).
---------------------------------------------------------------------------
The draft bill's focus on improving VA detection of domestic abuse
against veterans raises similar issues. VA's challenge in that regard
may be deeper than the lack of a screening tool. Facilities that are
already unable to provide timely, effective care to veterans with
combat-related mental health conditions are not likely to have the
requisite staffing, and may also lack the specialized expertise, to
provide the complex, sophisticated care needed by a victim of domestic
abuse. Again, we urge that broad oversight take precedence over
charting a legislative road that may risk establishing conflicting
priorities.
employment
With the many bills before the Committee today, Mr. Chairman, the
emphasis in our remarks on veterans' mental health reflects our view
that mental health is integral to overall health, and is very much at
the core of WWP's vision of fostering the most successful, well-
adjusted generation of veterans in the Nation's history. Too many
wounded warriors, however, have yet to regain mental health or to
achieve--or mount the first critical steps toward--success.
Our most recent survey of wounded warriors should be cause for deep
concern in that regard. That survey found that more than 17% of
respondents are unemployed (that is, have been looking for work for an
average of 26 weeks)--much higher than the 9.9% unemployment for all
veterans who served since 9/11 or the 10.9% rate among those deployed
to Iraq or Afghanistan.\7\ (Wounded warrior unemployment has not
changed materially since our 2012 survey.) That disturbingly high rate
of unemployment among those who have sacrificed so much merits close
scrutiny in reviewing legislation aimed at advancing veterans' economic
opportunities. It is critical, in our view, that wounded warriors are
afforded the tools, skills, resources, and supports needed to develop
meaningful and fulfilling careers. The goal should be economic
empowerment.
---------------------------------------------------------------------------
\7\ Franklin, 71.
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Given that perspective, we welcome the Committee's consideration of
S. 1262, the Veterans Conservation Corps Act, but recommend that the
bill be revised. The measure would authorize appropriations to VA of
$600 million over five years to employ veterans in conservation,
resource management, and historic preservation projects on public
lands; in cemetery maintenance and improvement projects; and as
firefighters, law enforcement officers, and disaster relief personnel,
with priority to those who served on or after 9/11.
WWP welcomes in principle the bill's focus on creating new job
opportunities for veterans, and the priority to be given employment for
Post-9/11 veterans. But with its job targets seemingly limited to
manual labor or work as first-responders, warriors whose severe
disabilities have already contributed to unemployment may find few
opportunities. We urge that the Committee further develop this bill,
and--particularly for wounded warriors--place greater emphasis on
career-building employment opportunities and on creating avenues to a
broader range of positions better suited to veterans whose disabilities
might rule out employment doing manual labor or as first-responders.
Given the importance of creating new opportunities for wounded
warriors that can lead to the development of new skills and career-
building employment opportunities, WWP also welcomes the Committee's
consideration of S. 1216, the Improving Job Opportunities for Veterans
Act of 2013. The central provision of that bill would require VA to
enter into agreements with the heads of other Federal departments and
agencies to operate on-the-job training programs to train eligible
veterans to perform skills necessary for employment by the department
or agency operating the program. Such programs hold promise and merit
development. We recommend, however, that the measure be amended to
establish a priority for service-disabled veterans in instances where
veterans' preference laws would not otherwise apply.
hearing loss and tinnitus
This Committee knows well that blast injuries in Iraq and
Afghanistan have left thousands of our warriors with severe
polytraumatic injuries. Those blasts have, of course, left many more
with debilitating invisible wounds, including severe hearing loss and
tinnitus. WWP's most recent survey of wounded warriors (with responses
from 52% of the almost 27 thousand whom we surveyed) illustrates the
prevalence of hearing impairment in this population. Almost 58% of
respondents sustained injuries as a result of blasts (including IED's,
mortars, and grenades).\8\ Not surprisingly then, more than 52%
experience tinnitus\9\ and 17.5% severe hearing loss.\10\ Overall, more
than half of all our respondents reported that their health is fair or
poor. But more than 60% of those with severe hearing loss described
themselves as being in only fair or poor health; of those with
tinnitus, 57% reported being in fair or poor health.
---------------------------------------------------------------------------
\8\ Id., 19
\9\ Id., 18
\10\ Id., 19
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Transition to civilian life and financial issues remain keen
concerns for our warriors,\11\ and VA benefits are necessarily vitally
important to their financial well-being. Yet in our recent survey,
42.5% of warriors with severe hearing loss and 41.8% of those with
tinnitus reported that their financial status is worse than a year
ago.\12\ Most VA hearing loss claims are adjudicated at 0% disabling,
and VA deems recurrent tinnitus to be only 10% disabling.\13\ Such
marginal compensation would seem to suggest that hearing impairment and
tinnitus cause only minimal impairment and have little to no effect on
average earning capacity. Veterans who live daily with hearing loss and
ringing in their ears would disabuse this Committee of any such
thought. Indeed VBA-convened medical experts have advised the
Department that its rating and testing criteria should be fundamentally
changed, and have recommended that tinnitus ratings should reflect
relative level of severity, with a rating of 60% for those with severe
disability.\14\ Those experts also faulted VA for evaluating hearing
loss in noise-free settings (in 93% of cases); such testing fails to
account for the loss of acuity and clarity that a hearing-impaired
individual experiences in the noisy, ``real-world'' settings where
veterans work and live.\15\
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\11\ Franklin, 121.
\12\ Id, 97.
\13\ B. Flohr and K. Dennis, ``Compensation and Pension Workshop,''
Academy of Federal Audiologists and Speech Language Pathologists
Conference, accessed at http://www.afaslp.org/AVAA%20conferences/
Dennis&Flohr2009_CP.pdf
\14\ ``VA Schedule for Rating Disabilities (VASRD) Improvement
Forum: Updating the VA's Disability Evaluation Criteria'' (New York
City), October 11, 2011.
\15\ Id.
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The Department of Veterans Affairs is responsible in law not simply
to adjudicate claims for service-incurred disability, but also to
update periodically the criteria for rating those disabilities as well
as to employ the most reliable clinical and technological means to
evaluate disability. While the Department has testified repeatedly to
the challenges it faces in its efforts to eliminate a deep backlog of
claims, it has been less forthcoming about the very limited progress
made to date in its long-ongoing effort to revise its rating criteria.
Revisions to the rating criteria for evaluating hearing impairment and
tinnitus are long overdue.
Mr. Chairman, we appreciate your work in crafting legislation aimed
at improving compensation for hearing loss. That legislation does raise
concerns, however. First, with VBA having already devoted several years
to reviewing these rating criteria, directing the Department to
report--conceivably two years from now--on issues regarding its
hearing-loss rating criteria could have the unintended effect of VA's
further deferring by several more years the development of these long-
overdue changes to the rating schedule. Second, insofar as the
legislation includes no reporting requirements specific to tinnitus, it
could be misconstrued to signal that the criteria for rating that
condition are not in question.
To the contrary, those who live with tinnitus would be quick to
explain that it is not a trivial or minimal annoyance. For many, the
condition interferes with sleep, hearing, concentration, thinking, and
emotional well-being. As discussed at a VA-sponsored VASRD forum on
audiology, surveys of people who suffer from blindness, loss of hearing
and severe tinnitus rated tinnitus as the most disabling.\16\ How then
does one explain rating criteria that assign only a 10% rating for this
condition? It would appear that VBA has capped the rating at 10% based
on a characterization of tinnitus' impairment as ``subjective'' in
nature. (Reviewing a decision point in the history of tinnitus
compensation, a VBA official explained that ``Because it remained a
subjective condition, the 10% limitation on disability was
continued.'') \17\ Yet the rating schedule is fundamentally
inconsistent in that regard. Medical science lacks objective tools to
measure the degree of impairment caused by mental health conditions,
for example; yet the VA rating schedule, however flawed in that regard,
certainly recognizes that mental illnesses can be totally disabling.
---------------------------------------------------------------------------
\16\ Id.
\17\ B. Flohr and K. Dennis, supra.
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In short, whether the Committee proceeds legislatively or through
oversight, we ask that you press for timely VA adoption of sound
criteria for rating both tinnitus and hearing loss.
automobile allowance
Just as compensation is critical to a wounded warrior's rebuilding
his or her life, having the mobility provided by an automobile or other
conveyance is often integral to a profoundly disabled individual's
combatting isolation and achieving maximum independence in the
community. With that perspective, we greatly appreciate the development
of draft legislation to improve the current automobile allowance
benefit. Your proposal, Mr. Chairman, would change the benefit from the
current one-time allowance to one that would permit an eligible veteran
to use the allowance to obtain two replacement vehicles, up to an
aggregate cap of $30,000, as adjusted annually by the consumer price
index. This represents a very important change--not only in its
recognition of the finite lifetime of even a very well-maintained
vehicle,\18\ but of the changing vehicular needs many young warriors
will experience as they start and grow families in the years ahead. We
appreciate the wisdom underlying this measure, and pledge our strong
support.
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\18\ See Polk survey, accessed at Forbes (http://www.forbes.com/
sites/jimgorzelany/2013/03/14/cars-that-can-last-for-250000-miles/).
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dental care
In closing, we note that the Committee has before it a number of
bills that reflect recognition of gaps in current law or in VA
programs. Some of those gaps are more obvious than others. In that
regard, S. , the Enhanced Dental Care for Veterans Act of 2013,
addresses what is clearly the limited scope of VA dental coverage. In
general (and with very limited exceptions), current law limits VA to
dental treatment of service-connected dental conditions or to coverage
for veterans who have a 100% service-connected rating. Among its
provisions, the bill would direct VA to carry out a pilot program at a
limited number of facilities through which enrolled veterans could be
afforded needed dental care up to a dollar amount of not less than
$1,000. This measure's underlying concern--that the scope of VA dental
coverage is unreasonably narrow--is sound. Especially troubling but
much less apparent, however, is that--with VA's longstanding claims
backlog--combat-injured veterans who should be afforded timely dental
treatment under existing law have been denied urgently needed VA dental
treatment because dental trauma had not yet been adjudicated service-
connected. To cite a specific case, it is untenable that a veteran who
in combat sustained head injuries with accompanying severe dental
trauma (circumstances explicitly covered under section 1712(a)(1)(C) of
title 38, U.S. Code), should have his need for dental treatment
deferred for an indefinite period pending a formal adjudication of
service-incurrence. Undoubtedly, the draftsman of this longstanding
authorization of VA dental care for service-connected dental trauma
would never have foreseen adjudication backlogs of the dimensions our
warriors face today. We urge that the Committee at its next markup
amend section 1712 to ensure that needed dental care to repair damage
caused by combat trauma is treated promptly, without any requirement
for formal adjudication of service-connection.
Thank you for your consideration of our views. We would welcome the
opportunity to work with the Committee to address further the important
matters discussed in this statement.